☰ INDEX
Arthritis-Arthritis
Arthritis-Previous_Year_Questions
Bone_Infections-Bone_and_Joint_Infections
Bone_Infections-Previous_Year_Questions
Bone_Tumors-Bone_Tumours
Bone_Tumors-Previous_Year_Questions
Bone_and_Imaging-Bone_and_Imaging-I
Bone_and_Imaging-Bone_and_Imaging-II
Bone_and_Imaging-Previous_Year_Questions
Complications_of_Fractures-Complications_in_Orthopedics
Complications_of_Fractures-Previous_Year_Questions
General-Miscellaneous_Topics_in_Orthopedics
General-Previous_Year_Questions
Images_and_Instruments-Orthopedic_Disorders_and_Instruments
Images_and_Instruments-Previous_Year_Questions
Lower_Limb_Traumatology-Previous_Year_Questions
Lower_Limb_Traumatology-Spine__Pelvis__and_Lower_Limb_Traumatology-I
Lower_Limb_Traumatology-Spine__Pelvis__and_Lower_Limb_Traumatology-II
Metabolic_Bone_Diseases-Metabolic_Disorders_in_Orthopedics
Metabolic_Bone_Diseases-Previous_Year_Questions
Nerve_Injuries-Peripheral_Nerve_Injuries
Nerve_Injuries-Previous_Year_Questions
Pediatric_Orthopedics-Pediatric_Orthopedics
Pediatric_Orthopedics-Previous_Year_Questions
Regional_Conditions-Previous_Year_Questions
Spine-Previous_Year_Questions
Sports_Injuries-Previous_Year_Questions
Sports_Injuries-Sports_Injuries
Tuberculosis_of_Bone_and_Joints-Previous_Year_Questions
Tuberculosis_of_Bone_and_Joints-TB_of_Bone
Upper_Limb_Traumatology-Previous_Year_Questions
Upper_Limb_Traumatology-Upper_Limb_Trauma-I
Upper_Limb_Traumatology-Upper_Limb_Trauma-II___Congenital_Torticollis
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She reports stiffness in the morning that lasts for less than 30 minutes and worsens after prolonged activity. On physical examination, there is tenderness, and swelling in both knees, with reduced range of movements and crepitus. An X-ray of the left knee is shown below. Despite conservative treatment, her pain persists. She is counseled on intra-articular injections. Which of the following is not an option for intra-articular treatment for her condition?", "options": [{"label": "A", "text": "Local anesthetic", "correct": false}, {"label": "B", "text": "Corticosteroid", "correct": false}, {"label": "C", "text": "Disease-modifying antirheumatic drugs (DMARDs)", "correct": true}, {"label": "D", "text": "Hyaluronic acid", "correct": false}], "correct_answer": "C. Disease-modifying antirheumatic drugs (DMARDs)", "question_images": ["https://image.prepladder.com/content/DSpWND3hKoroiJ1LGc451737798653.png"], "explanation_images": ["https://image.prepladder.com/content/7C39ImK0rVgBhCnXZGs91737798772.png", "https://image.prepladder.com/content/wLoqXasdRapLWJ12biBH1737798725.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:486px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Radiological features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pathology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Joint space narrowing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Focal areas of loss of <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> cartilage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Osteophytes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bone growth at the joint margins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sclerosis of <span class=\"customMeta\" data-dictid=\"70d8631e3c16927771992f8f444ab1\">subchondral</span> bone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sclerosis of underlying bone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone cysts</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cyst formation in underlying bone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone attrition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Loss of bone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Apparent effusions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Varying degrees of <span class=\"customMeta\" data-dictid=\"d27f9c7a1b16927771999b1679d949\">synovial</span> inflammation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Not visible on radiographs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fibrosis and thickening of the joint capsule</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fIV0MGEUVbrfMHwfcmbE1744787819.mp3", "video": ""}, {"text": "A 58-year-old man with a history of diabetes presents with the changes as shown in the image below. Which of the following features is not consistent with the X-ray foot findings?", "options": [{"label": "A", "text": "Distention", "correct": false}, {"label": "B", "text": "Density increase", "correct": false}, {"label": "C", "text": "Decreased joint space", "correct": true}, {"label": "D", "text": "Disorganization", "correct": false}], "correct_answer": "C. Decreased joint space", "question_images": ["https://image.prepladder.com/content/WWkz88o7TQvU5LVWOmFu1737799984.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:650px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Atrophic Charcot Joint</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Hypertrophic Charcot Joint</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Bone Resorption</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Yes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>No</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Osteolysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Yes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>No</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Common Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Forefoot</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Midfoot, rearfoot, ankle joint</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Localized bone loss</li>\n<li>Licked Candy stick appearance</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>6 D’s of Hypertrophy</strong></p>\n<ul>\n<li>Distended joints <strong>(Option A ruled out)</strong></li>\n<li>Density increases <strong>(Option B ruled out)</strong></li>\n<li>Debris production (loose body)</li>\n<li>Dislocation</li>\n<li>Disorganization <strong>(Option D ruled out)</strong></li>\n<li>Destruction</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/FHHhtH4rbsmKFpQC5PlI1744789012.mp3", "video": ""}, {"text": "Which of the following is a common joint pathology associated with the advanced stages of rheumatoid arthritis?", "options": [{"label": "A", "text": "Osteophyte formation", "correct": false}, {"label": "B", "text": "Fibrous or bony ankylosis and joint subluxation", "correct": true}, {"label": "C", "text": "Heberden's and Bouchard's nodes", "correct": false}, {"label": "D", "text": "Bone cyst formation", "correct": false}], "correct_answer": "B. Fibrous or bony ankylosis and joint subluxation", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/pVioRDivgVU57AAg1peZ1737795889.png", "https://image.prepladder.com/content/LyzUvlT6lltLZu7HP2OA1737795943.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/IHDSeiUeQoppVLwLhA6T1744785908.mp3", "video": ""}, {"text": "A 55-year-old female with a 15-year history of an unknown joint and bone condition presents with worsening bilateral knee pain and difficulty walking. Her physical exam pictures are shown below. She also reports recent fatigue and episodes of fever. Laboratory findings reveal neutropenia, and imaging shows splenomegaly. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Felty's syndrome", "correct": true}, {"label": "B", "text": "Psoriatic arthropathy", "correct": false}, {"label": "C", "text": "Kashin Beck disease", "correct": false}, {"label": "D", "text": "Pseudogout", "correct": false}], "correct_answer": "A. Felty's syndrome", "question_images": ["https://image.prepladder.com/content/GJddutf7RrV2UizMs3u61737796052.png", "https://image.prepladder.com/content/dejaz07OjBuTgFS6kip41737796192.png"], "explanation_images": ["https://image.prepladder.com/content/yQwa2yfanPMbizxBYaYM1737796092.png", "https://image.prepladder.com/content/MpG6rrLIsM0Di7r2PIRg1737796076.png", "https://image.prepladder.com/content/t3Jczy4WFfLMWFviVIaT1737796172.png", "https://image.prepladder.com/content/OLzO06ATbACdfHtj7bmf1737796721.png", "https://image.prepladder.com/content/Vd0cfR5PQj4epXUnzxd51737796543.png", "https://image.prepladder.com/content/6tZsmGzaaVDuLXBsVxA71737796329.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:389px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Joints affected</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>MP joints of the hand</li>\n<li>PIP joints of fingers</li>\n<li>Wrists, knees, elbows, ankles</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less common</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hip joint</li>\n<li>Temporo-mandibular joint</li>\n<li>Spares <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joint and <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"8571221d1416927771909046a403e4\">inter</span> <span class=\"customMeta\" data-dictid=\"b9f9358d0d1692777195323daee87f\">phalangeal</span> joints.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:572px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Deformities in <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">Rheumatoid</span> arthritis</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hand</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ulnar <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> of the hand</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Andreas L Birkenfeld Ute Kettritz Jan Hinrich Bräsen Ursula Göbel\" data-hash=\"\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.researchgate.net/figure/Rheumatoid-arthritis-with-ulnar-deviation-of-the-metacarpal-phalangeal-joints-button_fig1_325272407\" data-tags=\"\" height=\"248\" src=\"https://image.prepladder.com/content/yQwa2yfanPMbizxBYaYM1737796092.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Swan neck deformity</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"334\" src=\"https://image.prepladder.com/content/MpG6rrLIsM0Di7r2PIRg1737796076.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Boutonniere deformity</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Prasanthnsz\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Boutonniere_deformity#/media/File:RA_hand_deformity.JPG\" data-tags=\"\" height=\"367\" src=\"https://image.prepladder.com/content/t3Jczy4WFfLMWFviVIaT1737796172.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elbow</p>\n<ul>\n<li>Flexion deformity</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Knee</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Valgus deformity</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Biomed Central\" data-hash=\"\" data-license=\"CC BY 2.0\" data-source=\"https://en.wikipedia.org/wiki/Valgus_deformity#/media/File:Valgus.jpg\" data-tags=\"\" height=\"278\" src=\"https://image.prepladder.com/content/OLzO06ATbACdfHtj7bmf1737796721.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ankle</p>\n<ul>\n<li>Equinus deformity</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Foot</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hallux valgus</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Cyberprout\" data-hash=\"\" data-license=\"CC BY SA 1.0\" data-source=\"https://en.wikipedia.org/wiki/Bunion#/media/File:Hallux_Valgus-Aspect_pr%C3%A9_op_d%C3%A9charge.JPG\" data-tags=\"\" height=\"509\" src=\"https://image.prepladder.com/content/Vd0cfR5PQj4epXUnzxd51737796543.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hammer toe</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Wwcmdmsa\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Hammer_toe#/media/File:Hammer_toes.jpg\" data-tags=\"\" height=\"427\" src=\"https://image.prepladder.com/content/6tZsmGzaaVDuLXBsVxA71737796329.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/dEG8AFHVf2uzY4KllduN1744786053.mp3", "video": ""}, {"text": "A 42-year-old woman presents with a 6-month history of joint pain, stiffness, and swelling, primarily affecting her hands and wrists. She reports that the stiffness is worse in the morning and lasts for over an hour. On examination, there is tenderness and swelling in multiple small joints, and her grip strength is reduced. An X-ray of the hands is shown below. Laboratory investigations reveal elevated ESR, C-reactive protein (CRP), positive rheumatoid factor (RF), and normal liver function tests and complete blood count. After temporary symptom relief with NSAIDs which of the following is the first line of treatment in this patient?", "options": [{"label": "A", "text": "Hydroxychloroquine (HCQ)", "correct": false}, {"label": "B", "text": "Leflunomide", "correct": false}, {"label": "C", "text": "Sulfasalazine", "correct": false}, {"label": "D", "text": "Methotrexate", "correct": true}], "correct_answer": "D. Methotrexate", "question_images": ["https://image.prepladder.com/content/45DUuXpcdwkziImpTVbQ1737797749.png"], "explanation_images": ["https://image.prepladder.com/content/FB4Z3aE6hRk9ue69N3k21737797906.png", "https://image.prepladder.com/content/dB4PvtuvNrcykItEx60J1737797831.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/MDlckuKFUhuK9yDONJ741744787089.mp3", "video": ""}, {"text": "In primary osteoarthritis, systemic and mechanical factors interact to trigger the early stages of cartilage degeneration. Which of the following is the earliest pathological change observed in osteoarthritis?", "options": [{"label": "A", "text": "Synovial inflammation and capsular thickening", "correct": false}, {"label": "B", "text": "Increased water content in the cartilage", "correct": true}, {"label": "C", "text": "Osteophyte formation at the margins", "correct": false}, {"label": "D", "text": "Exposure of underlying subchondral bone", "correct": false}], "correct_answer": "B. Increased water content in the cartilage", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/x4Fq4cJJouxjyQHkJJoG1744787221.mp3", "video": ""}, {"text": "A 65-year-old woman presents with progressively worsening knee pain over the past 6 years. She reports stiffness in the morning that lasts for less than 30 minutes and worsens after prolonged activity. She denies any history of trauma or systemic inflammatory disease. On physical examination, there is tenderness, and swelling in both knees, with reduced range of movements and crepitus, tenderness over proximal interphalangeal (PIP) joints and distal interphalangeal (DIP) joints, along with squaring at the base of the thumb. X-rays of the knees show joint space narrowing, osteophyte formation, and subchondral sclerosis. Which of the following findings in PIP joints is characteristic of her condition?", "options": [{"label": "A", "text": "Bouchard’s nodes", "correct": true}, {"label": "B", "text": "Boutonniere deformity", "correct": false}, {"label": "C", "text": "Heberden’s nodes", "correct": false}, {"label": "D", "text": "Rheumatoid nodules", "correct": false}], "correct_answer": "A. Bouchard’s nodes", "question_images": ["https://image.prepladder.com/content/BrTeMLBLmi8MG6VQlput1737798541.png"], "explanation_images": ["https://image.prepladder.com/content/7AgwElSyUZntkqhxA8Y21737798077.png", "https://image.prepladder.com/content/qsKFCZEUAIR5PW7CNkGG1737798155.png", "https://image.prepladder.com/content/p6pYY6pmVj0m8sp9tT0i1737798452.png", "https://image.prepladder.com/content/rKAoaK2fFyYiJj4e0hhZ1737798051.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/wjLBJkQqtGss9O6ls8yy1744787686.mp3", "video": ""}, {"text": "A 52-year-old woman presents with swelling and limited mobility in her right shoulder, having experienced a sudden onset three weeks ago. Upon inspection, the right shoulder is swollen, non-tender, and erythematous. She reports a history of unnoticed burns on her hands and neck from cooking and using a hairdryer. An MRI of the cervical spine is given below. An indium WBC scan was performed, and the result was negative. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Osteoarthritis", "correct": false}, {"label": "B", "text": "Charcot arthropathy", "correct": true}, {"label": "C", "text": "Osteomyelitis", "correct": false}, {"label": "D", "text": "DVT", "correct": false}], "correct_answer": "B. Charcot arthropathy", "question_images": ["https://image.prepladder.com/content/GQcbcK5qY441ExHCLHw21737799566.png"], "explanation_images": ["https://image.prepladder.com/content/V2XztZOr9YaDXv62LUEj1737799760.png", "https://image.prepladder.com/content/OGDDnyGtDF6pVdw1Ulmg1737799849.png", "https://image.prepladder.com/content/tcqZbKgRTsNt10GbdhGo1737799806.png", "https://image.prepladder.com/content/UGqUxkghPSWWU8Phr8Jd1737799776.png", "https://image.prepladder.com/content/23PHnIiPKMKlyj5UyfYa1737799827.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Common Joint Involved</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Diabetes mellitus (Most common cause)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Peripheral <span class=\"customMeta\" data-dictid=\"2d9476094c16927771933bcb162f19\">neuropathy</span> leads to altered pain sensation and proprioception</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Foot</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"398\" src=\"https://image.prepladder.com/content/OGDDnyGtDF6pVdw1Ulmg1737799849.png\" width=\"300\"/></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Syphilis (Tabes dorsalis)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Neurological deficits affecting joint function</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Knee</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"150\" src=\"https://image.prepladder.com/content/tcqZbKgRTsNt10GbdhGo1737799806.png\" width=\"208\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Syringomyelia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Dilatation of the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord; may lead to <span class=\"customMeta\" data-dictid=\"4eac1cd2f016927771990c099e203d\">syringobulbia</span> (if it extends to the Brainstem)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Shoulder</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"387\" src=\"https://image.prepladder.com/content/UGqUxkghPSWWU8Phr8Jd1737799776.png\" width=\"293\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Leprosy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Neuropathy leading to loss of sensation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Hand and Foot</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"113\" src=\"https://image.prepladder.com/content/23PHnIiPKMKlyj5UyfYa1737799827.png\" width=\"201\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Meningomyelocele</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Neurological deficits impacting joint function</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Variable, but often lower limbs</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/iAN1skbW6GuAfxXp8Zlj1744788418.mp3", "video": ""}, {"text": "A 58-year-old female with a 15-year history of diabetes presents with a chronic charcot foot deformity in her right foot, accompanied by recurrent ulcerations. She has previously undergone treatment with total contact casting but continues to have instability and pain. What is the next best step for her?", "options": [{"label": "A", "text": "Management with offloading and regular follow-up", "correct": false}, {"label": "B", "text": "Initiate pharmacologic therapy with bisphosphonates", "correct": false}, {"label": "C", "text": "Schedule surgical arthrodesis with internal fixation", "correct": true}, {"label": "D", "text": "Refer for amputation of the affected foot", "correct": false}], "correct_answer": "C. Schedule surgical arthrodesis with internal fixation", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/2BDgD1369IMHaPyMFM1e1737800335.png", "https://image.prepladder.com/content/c18VXbSlZgkl6TkDF9QB1737800297.png", "https://image.prepladder.com/content/QhKPrjX0h8DrrXvSkIAy1737800144.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>General Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Vascular Management:</strong>\n<ul>\n<li>Vasodilators improve blood flow</li>\n<li>Pentoxifylline enhances <span class=\"customMeta\" data-dictid=\"8790b4667016927771979066e8958c\">RBC</span> flexibility, promotes wound healing, and maintains vascularity.</li>\n</ul>\n</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Infection Control</strong>: Antibiotics are essential for managing and preventing infection.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Acute Arthropathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Immobilization:</strong> Minimizes movement to protect the affected area</li>\n<li><strong>Total Contact <span class=\"customMeta\" data-dictid=\"8c6ba9ffab1692777183324e3a5ed3\">Casting</span> (TCC) </strong>:\n\t\t\t\t<ul>\n<li>Provides pressure relief while allowing mobility</li>\n<li>Encase foot and lower leg, redistributing weight with regular checks for fit(weekly) &amp; replace them every 2 weeks.</li>\n<li>The aim of TCC is to keep the patient mobile</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Chronic arthropathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Rest: Essential for recovery and reducing stress on the affected area</li>\n<li><strong>Braces</strong>: Patellar <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">Tendon</span> <span class=\"customMeta\" data-dictid=\"2bb6ddacfd169277718230a816b21f\">Bearing</span> (PTB) <span class=\"customMeta\" data-dictid=\"ea9813b91c169277718305c8fe4777\">Brace</span> supports <span class=\"customMeta\" data-dictid=\"650eb29fb9169277719270ea0fbea5\">mobility</span> and redistributes pressure</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/2BDgD1369IMHaPyMFM1e1737800335.png\" width=\"1999\"/></p>\n<ul>\n<li><strong>Orthotics:</strong> Charcot <span class=\"customMeta\" data-dictid=\"cff53074aa1692777197de61c598a4\">Restraint</span> Orthotic <span class=\"customMeta\" data-dictid=\"c8876c29d3169277720249023a4fdd\">Walker</span> prevents further damage to Charcot’s joint.</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"420\" src=\"https://image.prepladder.com/content/c18VXbSlZgkl6TkDF9QB1737800297.png\" width=\"860\"/></p>\n<ul>\n<li><strong>Surgical Treatment</strong></li>\n<li><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1691\" src=\"https://image.prepladder.com/content/QhKPrjX0h8DrrXvSkIAy1737800144.png\" width=\"1999\"/></li>\n</ul>\n<p> </p>\n<ul>\n<li>Includes <span class=\"customMeta\" data-dictid=\"61e4fc8326169277719471f9c16b02\">Open Reduction</span> Internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">Fixation</span> (ORIF) for complex fractures</li>\n<li>Excision of bony prominences</li>\n<li>Reconstruction to restore structure</li>\n<li>Arthrodesis to <span class=\"customMeta\" data-dictid=\"30bdb5481f1692777203cbadf50a71\">fuse</span> joints</li>\n<li>Amputation in severe cases.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/7fPg7vxiQQT77xCiNgj71745756699.mp3", "video": ""}, {"text": "A 12-year-old boy with a history of severe hemophilia A presents with recurrent episodes of knee swelling and pain. On examination, his knee shows significant effusion and tenderness, and the physician suspects pathologic changes in the joint. Which of the following best describes the pathogenesis of the joint changes observed in this condition?", "options": [{"label": "A", "text": "Increased osteoclast activity leading to bone resorption", "correct": false}, {"label": "B", "text": "Hyperplastic vascularity and inflammation in the synovial membrane", "correct": true}, {"label": "C", "text": "Accumulation of uric acid crystals in the joint space", "correct": false}, {"label": "D", "text": "Immune-mediated damage to the cartilage due to systemic inflammation", "correct": false}], "correct_answer": "B. Hyperplastic vascularity and inflammation in the synovial membrane", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/lbiZLYcKuEHsKVB44fca1737800487.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:626px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Coagulation Pathway</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Altered <span class=\"customMeta\" data-dictid=\"a6795c876e169277719057a1099465\">intrinsic</span> <span class=\"customMeta\" data-dictid=\"3aa5abc2fa169277719488e088076d\">pathway</span> leading to <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> tendency</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Types of Hemophilia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Type A (Absence of factor VIII, 85%)</li>\n<li>Type B (Absence of factor IX, 15%)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Primary Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Chronic and <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> exposure of <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> and <span class=\"customMeta\" data-dictid=\"4d5c42a8591692777199d8e337af3f\">synovium</span> to metabolized blood products</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Consequences of Blood in Joint</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Hypervascular <span class=\"customMeta\" data-dictid=\"d27f9c7a1b16927771999b1679d949\">synovial</span> hypertrophy</li>\n<li>Chronic synovitis</li>\n<li>Articular <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> damage</li>\n<li>Bony hypertrophy</li>\n<li>Subchondral cysts</li>\n<li>Joint surface loses its luster and becomes eroded in” Rivet-like tracts”</li>\n<li>In end-stage disease, the densely pigment-stained hyperplastic <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> undergoes <span class=\"customMeta\" data-dictid=\"cb4dfcbab11692777192d282b3be7a\">metaplasia</span> to <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> tissue, and contractures develop, eventually leading to <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> ankylosis</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1583\" src=\"https://image.prepladder.com/content/lbiZLYcKuEHsKVB44fca1737800487.png\" width=\"1999\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/JtppKsRXvvxm7Vujp0Ly1744789694.mp3", "video": ""}, {"text": "A 15-year-old boy with hemophilia B presents for a follow-up appointment. He has a history of recurrent hemarthroses in his left knee, which has progressively become painful and swollen. The physician orders an X-ray to assess the current state of the joint. Which of the following stages is most consistent with the given X-ray?", "options": [{"label": "A", "text": "Stage 5", "correct": false}, {"label": "B", "text": "Stage 4", "correct": false}, {"label": "C", "text": "Stage 3", "correct": true}, {"label": "D", "text": "Stage 2", "correct": false}], "correct_answer": "C. Stage 3", "question_images": ["https://image.prepladder.com/content/3vN75KOBFqPFhMHcUOFp1737950572.png"], "explanation_images": ["https://image.prepladder.com/content/fve1o6XFIpr9aLBCx8Ee1737950412.png", "https://image.prepladder.com/content/uvTwJHV3bZjfvuEsGv551737950541.png", "https://image.prepladder.com/content/laaNVrSQu9VzA7Aw6Bcj1737950518.png", "https://image.prepladder.com/content/VvyaxAAHXaAt8xvX2TAC1737950594.png", "https://image.prepladder.com/content/6ou5miLXVPuUHq86TV6E1737950473.png", "https://image.prepladder.com/content/VIhL2TohfTTK06i19T9Z1737950491.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Stage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Findings</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>I</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>No skeletal abnormalities</li>\n<li>Soft tissue swelling</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/fve1o6XFIpr9aLBCx8Ee1737950412.png\" width=\"1999\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>II</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Osteoporosis</li>\n<li>Overgrowth of epiphysis.</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/uvTwJHV3bZjfvuEsGv551737950541.png\" width=\"1999\"/></p>\n<ul>\n<li>No erosions.</li>\n<li>No narrowing of <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> space</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>III</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Early <span class=\"customMeta\" data-dictid=\"70d8631e3c16927771992f8f444ab1\">subchondral</span> bone cysts</li>\n<li>Squaring of the patella.</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/laaNVrSQu9VzA7Aw6Bcj1737950518.png\" width=\"1999\"/></p>\n<ul>\n<li>Intercondylar <span class=\"customMeta\" data-dictid=\"80dc1890d11692777193322fc863b1\">notch</span> of <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> and <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> widened.</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"729\" src=\"https://image.prepladder.com/content/VvyaxAAHXaAt8xvX2TAC1737950594.png\" width=\"340\"/></p>\n<ul>\n<li>Cartilage space remains preserved</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>IV</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Findings of stage III more advanced.</li>\n<li>Cartilage space narrowed significantly</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/6ou5miLXVPuUHq86TV6E1737950473.png\" width=\"1999\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>V</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>End stage.</li>\n<li>Fibrous joint contracture</li>\n<li>Loss of joint <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> space</li>\n<li>Marked <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> of the epiphyses</li>\n<li>Substantial <span class=\"customMeta\" data-dictid=\"ca98b707ae169277718627c9aaf630\">disorganization</span> of the joints</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/VIhL2TohfTTK06i19T9Z1737950491.png\" width=\"1999\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/kga4XLRl1JPrpnAqsTiy1744789991.mp3", "video": ""}, {"text": "A 10-year-old boy with severe hemophilia A presents to the emergency department with a swollen, painful right knee after falling while playing a few hours ago. His mother reports that he has had similar episodes in the past. Which of the following is the next best step?", "options": [{"label": "A", "text": "Administer oral NSAIDs and discharge home", "correct": false}, {"label": "B", "text": "Perform joint aspiration and factor replacement", "correct": true}, {"label": "C", "text": "Immobilize the knee in a flexed position", "correct": false}, {"label": "D", "text": "Refer for immediate surgical synovectomy", "correct": false}], "correct_answer": "B. Perform joint aspiration and factor replacement", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Acute Hemarthrosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Aspiration:</strong> Aggressive management with <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> of the joint.</li>\n<li><strong>Factor Replacement</strong>: Regular replacement of <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors (e.g., Factor VIII/IX) to prevent further bleeding.</li>\n<li><strong>NSAIDs: </strong>Use of Cox-2 inhibitors or <span class=\"customMeta\" data-dictid=\"5778d7dc361692777189571125f0bd\">ibuprofen</span> for pain relief.</li>\n<li><strong>Bupivacaine &amp; Corticosteroids</strong>: <span class=\"customMeta\" data-dictid=\"bcf4f8a2be16927771907cf5f046c5\">Instillation</span> during <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> to reduce rebleeding risk.</li>\n<li><strong>Bed Rest &amp; Immobilization: </strong>Strict <span class=\"customMeta\" data-dictid=\"63b27629261692777182cc4d582eca\">bed rest</span> and limb <span class=\"customMeta\" data-dictid=\"3024d9916e16927771896f5b7159b6\">immobilization</span> in extension.</li>\n<li><strong>Emergent Considerations:</strong> Special care for <span class=\"customMeta\" data-dictid=\"c219021c491692777189d289f1fc03\">immature</span> hip to prevent osteonecrosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Primary Prophylaxis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Initiated in <span class=\"customMeta\" data-dictid=\"663d16ec8e169277719095f74c9816\">infancy</span> to prevent future hemarthroses and long-term disability.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Surgery (Elective)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Pre-Surgery Factor Replacement:</strong>\n<ul>\n<li>Infusion 2 hours before surgery to achieve 100% factor activity</li>\n<li>continuous <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> to maintain &gt;60% during and after surgery.</li>\n</ul>\n</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Post-Surgery Monitoring:</strong> Check factor levels immediately after and then every 1-2 days.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Chronic Arthritis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Synovectomy:</strong>\n<ul>\n<li>Open or arthroscopic <span class=\"customMeta\" data-dictid=\"258ed452c21692777199f0baaab113\">synovectomy</span> for <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> hemarthrosis</li>\n<li>recommended if <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> occurs &gt;3 times in 6 months.</li>\n</ul>\n</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Radiosynovectomy:</strong>\n<ul>\n<li>For patients with multiple joint involvement or inhibitors.</li>\n<li>With <span class=\"customMeta\" data-dictid=\"25213d41c816927772029ea1c0e76b\">Yttrium</span> 90 <span class=\"customMeta\" data-dictid=\"283185130016927771986008a1316f\">silicate</span> or <span class=\"customMeta\" data-dictid=\"bfea0730ac16927771959eb551740f\">Phosphorus</span> 31 colloid</li>\n</ul>\n</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Surgical Principles: (Post &amp; Telfer)</strong>\n<ul>\n<li>Tight wound closure</li>\n<li>No electrocautery, wound suction</li>\n<li>Avoid certain medications post-op.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Specific <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> Interventions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Knee:</strong> <span class=\"customMeta\" data-dictid=\"5e24bec3b21692777200994abd1bbd\">TKA</span> indicated in advanced cases; patellar resurfacing recommended.</li>\n<li><strong>Elbow:</strong> <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">Radial</span> head <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with <span class=\"customMeta\" data-dictid=\"258ed452c21692777199f0baaab113\">synovectomy</span> for <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> hemarthrosis.</li>\n<li><strong>Hip: </strong>Total hip replacement for good outcomes.</li>\n<li><strong>Shoulder:</strong> <span class=\"customMeta\" data-dictid=\"129c645fde1692777182cf1d3e1ecc\">Arthrodesis</span> or <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> replacement options.</li>\n<li><strong>Ankle</strong>: <span class=\"customMeta\" data-dictid=\"129c645fde1692777182cf1d3e1ecc\">Arthrodesis</span> for chronic arthritis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Flexion Contractures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Correction: Recommended <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> of <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> contractures &gt;30° before surgery.</li>\n<li>Hamstring Release: For knee <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> contractures &lt;45° not amenable to conservative treatment.</li>\n<li>Osteotomy: Severe cases may require <span class=\"customMeta\" data-dictid=\"043a86fa0016927771998a67e65e6a\">supracondylar</span> osteotomy.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/hD7YjwooggmZ9C02oGW41744814560.mp3", "video": ""}, {"text": "A 38-year-old female with a history of psoriasis develops joint pain. Which of the following genetic markers is most commonly associated with psoriatic arthritis, but present in only 50- 60% of cases?", "options": [{"label": "A", "text": "HLA-DR4", "correct": false}, {"label": "B", "text": "HLA-B27", "correct": true}, {"label": "C", "text": "HLA-DQ2", "correct": false}, {"label": "D", "text": "HLA-A1", "correct": false}], "correct_answer": "B. HLA-B27", "question_images": ["https://image.prepladder.com/content/McJZFRpFlMLdAMQ317ee1737950737.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/yVtNSxysua5WwqzGk05J1744814647.mp3", "video": ""}, {"text": "Which of the following is false regarding the clinical manifestation of psoriatic arthritis?", "options": [{"label": "A", "text": "It can present with both distal interphalangeal joint arthritis and spondylitis.", "correct": false}, {"label": "B", "text": "Enthesitis, especially at the Achilles tendon insertion may be present.", "correct": false}, {"label": "C", "text": "Psoriatic arthritis typically presents with symmetrical arthritis in large joints.", "correct": true}, {"label": "D", "text": "Arthritis mutilans can lead to severe deformities in the fingers and toes.", "correct": false}], "correct_answer": "C. Psoriatic arthritis typically presents with symmetrical arthritis in large joints.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ScSzmKbFe5KTWa3CJ3Vh1737950863.png", "https://image.prepladder.com/content/k3b6VSRxR0Ar49WD66eg1737950811.png", "https://image.prepladder.com/content/BARqQeQdajW9cuMMNA531737950923.png", "https://image.prepladder.com/content/pUUZ9WyAAD3VU0eb3uQq1737950894.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/rQggOrZjfD5BIfb6JU3o1744814764.mp3", "video": ""}, {"text": "A 38-year-old male with a 10-year history of psoriasis presents to the clinic with complaints of pain and swelling in his fingers and lower back stiffness for the past several months. On examination, there is swelling of the distal interphalangeal joints (DIP) of both hands, and tenderness in the sacroiliac region. His erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are elevated, but rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies are negative. Which of the following radiological findings is NOT commonly associated with his condition?", "options": [{"label": "A", "text": "Erosive changes and joint space narrowing", "correct": false}, {"label": "B", "text": "New bone formation and bony ankylosis", "correct": false}, {"label": "C", "text": "Periarticular osteopenia with marginal erosions", "correct": true}, {"label": "D", "text": "Syndesmophyte formation in the spine", "correct": false}], "correct_answer": "C. Periarticular osteopenia with marginal erosions", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/EmU311snFqs2LSiYR8f31737951010.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/DB8Rj3qUZfsQ9Acc1l121744814938.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 25 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 15</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Arthritis-Previous Year Questions - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 15</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 15 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "In the outpatient department, a female patient presents with arthritis that symmetrically affects multiple joints, including the wrists, hands, and feet. The patient reports morning stiffness lasting for more than 1 hour, and examination reveals swollen and tender joints.", "options": [{"label": "A", "text": "Rheumatoid arthritis", "correct": true}, {"label": "B", "text": "Psoriatic arthritis", "correct": false}, {"label": "C", "text": "Osteoarthritis", "correct": false}, {"label": "D", "text": "Gout", "correct": false}], "correct_answer": "A. Rheumatoid arthritis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Joint involved &amp; characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Joint spared</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Osteoarthritis (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Proximal and <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">Distal</span> <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joints (PIP and DIP), 1st <span class=\"customMeta\" data-dictid=\"3787fbc7ad1692777183a3b034298d\">Carpometacarpal</span> joint, Hip and knee</li>\n<li>Asymmetrical involvement</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Wrist and <span class=\"customMeta\" data-dictid=\"d7e158e089169277719265674b2879\">Metacarpophalangeal</span> (MCP) joints</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rheumatoid <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Metacarpophalangeal joint (MCP) - most commonly involved</li>\n<li><strong>Symmetrical involvement</strong> seen</li>\n<li><strong>Morning stiffness</strong> present</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Distal <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joints (DIP) and 1st <span class=\"customMeta\" data-dictid=\"3787fbc7ad1692777183a3b034298d\">carpometacarpal</span> (CMP) joint</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Psoriatic <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Proximal and <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">Distal</span> <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joints (PIP and DIP)</li>\n<li>Pencil-in-cup, telescoping of digits, <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> mutilans</li>\n<li>Skin and nail involvement +</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ray pattern distribution of joints seen</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Rheumatoid <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> (RA) is a common chronic <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> joint disease characterized by <span class=\"customMeta\" data-dictid=\"d963da62eb16927771993737a99c7c\">symmetrical</span> polyarthritis, tenosynovitis, morning stiffness, elevated ESR, and presence of autoantibodies (RF and ACPA). It’s a <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> condition affecting various tissues.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Genetic <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> (e.g., HLA-DR4 association).</li>\n<li>Immunological reaction involving <span class=\"customMeta\" data-dictid=\"d27f9c7a1b16927771999b1679d949\">synovial</span> tissue.</li>\n<li>Inflammatory response in joints and <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> sheaths.</li>\n<li><strong>Rheumatoid factors (RF)</strong> and <strong>anti-citrullinated peptides (ACPA/ anti-CCP antibodies)</strong>.</li>\n<li>Articular <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> destruction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Stage 1: Pre-clinical- Immune changes begin, detectable ESR, CRP, and RF.</li>\n<li>Stage 2: Synovitis- Inflammation, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> congestion, and <span class=\"customMeta\" data-dictid=\"d7fffc236b16927771995b5f4be17b\">synoviocyte</span> proliferation.</li>\n<li>Stage 3: Destruction- Joint and <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> damage, <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> erosion, and bone resorption.</li>\n<li>Stage 4: Deformity- Joint instability, capsular stretching, and <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> leading to deformity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Early: Pain, swelling, <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> in small joints (e.g., fingers, wrists), especially after inactivity.</li>\n<li>Later: Joint <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> (e.g., <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> deviation, clawed toes), restricted movements, and constant ache.</li>\n<li>Extra-articular features include <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> nodules, muscle wasting, scleritis, and vasculitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Named deformities in RA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Boutonnière deformity:</strong> Also known as <span class=\"customMeta\" data-dictid=\"029dfebce81692777183edaa12280a\">buttonhole</span> deformity, this occurs when the middle joint of a finger <span class=\"customMeta\" data-dictid=\"247e7aa0181692777182e46b52832d\">bends</span> downward, while the top joint <span class=\"customMeta\" data-dictid=\"247e7aa0181692777182e46b52832d\">bends</span> away from the palm.</li>\n<li><strong>Swan-neck deformity: </strong>This occurs when the base and top joint of a finger bend downward, while the middle joint is straight.</li>\n<li><strong>Ulnar deviation: </strong>Also known as <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> drift, this occurs when fingers bend toward the outer side of the forearm.</li>\n<li><strong>Hitchhiker's thumb: </strong>Also known as Z-shaped deformity, this occurs when the thumb flexes at the joint where it meets the palm, then <span class=\"customMeta\" data-dictid=\"247e7aa0181692777182e46b52832d\">bends</span> backward at the joint below the thumbnail.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly patient with the presented deformity was brought to the outpatient department (OPD). What is the likely diagnosis?", "options": [{"label": "A", "text": "Rickets", "correct": false}, {"label": "B", "text": "Osteomalacia", "correct": false}, {"label": "C", "text": "Osteoarthritis", "correct": false}, {"label": "D", "text": "Rheumatoid arthritis", "correct": true}], "correct_answer": "D. Rheumatoid arthritis", "question_images": ["https://image.prepladder.com/content/ONbAPTj5OlEHgX7nJRfr1746179018.png"], "explanation_images": ["https://image.prepladder.com/content/KZIBmGzbMSNmTdKC8l2r1746179347.png", "https://image.prepladder.com/content/sIFVBreCgf1T0eFieOlb1746179342.png", "https://image.prepladder.com/content/l9afBF87vmuHdP3oeV4w1746179337.png", "https://image.prepladder.com/content/GSs0kzoBewKcnmSesy4Z1746179332.png", "https://image.prepladder.com/content/zgIOzsr2AUHMPS6hg7tx1746179325.png", "https://image.prepladder.com/content/w7mSDCmETHXdWTY6Ecof1746179320.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:389px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Joints affected</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>MP joints of the hand</li>\n<li>PIP joints of fingers</li>\n<li>Wrists, knees, elbows, ankles</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Less common</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hip joint</li>\n<li>Temporo-mandibular joint</li>\n<li>Spares <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joint and <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"8571221d1416927771909046a403e4\">inter</span> <span class=\"customMeta\" data-dictid=\"b9f9358d0d1692777195323daee87f\">phalangeal</span> joints.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td colspan=\"2\"><strong>Deformities in <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">Rheumatoid</span> arthritis</strong></td>\n</tr>\n<tr>\n<td colspan=\"2\">Hand</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:162px; vertical-align:top; width:240px\">\n<ul>\n<li>Ulnar <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> of the hand</li>\n</ul>\n</td>\n<td>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Andreas L Birkenfeld Ute Kettritz Jan Hinrich Bräsen Ursula Göbel\" data-hash=\"\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.researchgate.net/figure/Rheumatoid-arthritis-with-ulnar-deviation-of-the-metacarpal-phalangeal-joints-button_fig1_325272407\" data-tags=\"\" height=\"213\" src=\"https://image.prepladder.com/content/KZIBmGzbMSNmTdKC8l2r1746179347.png\" width=\"432\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:19px; vertical-align:top; width:240px\">\n<ul>\n<li>Swan neck deformity</li>\n</ul>\n</td>\n<td>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"User:Phoenix119 \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Swan_neck_deformity#/media/File:Swan_neck_deformity_in_a_65_year_old_Rheumatoid_Arthritis_patient-_2014-05-27_01-49.jpg\" data-tags=\"\" height=\"277\" src=\"https://image.prepladder.com/content/sIFVBreCgf1T0eFieOlb1746179342.png\" width=\"402\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:19px; vertical-align:top; width:240px\">\n<ul>\n<li>Boutonniere deformity</li>\n</ul>\n</td>\n<td>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"John Kiel\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://wikism.org/File:Boutonniere_Deformity_Clinical_Image.jpg\" data-tags=\"\" height=\"305\" src=\"https://image.prepladder.com/content/l9afBF87vmuHdP3oeV4w1746179337.png\" width=\"406\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:19px; vertical-align:top; width:240px\">\n<p>Elbow: Flexion deformity</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:19px; vertical-align:top; width:240px\">Knee</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:19px; vertical-align:top; width:240px\">\n<ul>\n<li>Valgus deformity</li>\n</ul>\n</td>\n<td>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"BioMed central\" data-hash=\"\" data-license=\"CC BY 2.0\" data-source=\"https://en.wikipedia.org/wiki/Valgus_deformity#/media/File:Valgus.jpg\" data-tags=\"\" height=\"281\" src=\"https://image.prepladder.com/content/GSs0kzoBewKcnmSesy4Z1746179332.png\" width=\"404\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:19px; vertical-align:top; width:240px\">Ankle: Equinus deformity</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:19px; vertical-align:top; width:240px\">Foot</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:19px; vertical-align:top; width:240px\">\n<ul>\n<li>Hallux valgus</li>\n</ul>\n</td>\n<td>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Cyberprout\" data-hash=\"\" data-license=\"CC BY SA 1.0\" data-source=\"https://en.wikipedia.org/wiki/Bunion#/media/File:Hallux_Valgus-Aspect_pr%C3%A9_op_d%C3%A9charge.JPG\" data-tags=\"\" height=\"385\" src=\"https://image.prepladder.com/content/zgIOzsr2AUHMPS6hg7tx1746179325.png\" width=\"303\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:19px; vertical-align:top; width:240px\">\n<ul>\n<li>Hammer toe</li>\n</ul>\n</td>\n<td>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Wwcmdmsha\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Hammer_toe#/media/File:Hammer_toes.jpg\" data-tags=\"\" height=\"366\" src=\"https://image.prepladder.com/content/w7mSDCmETHXdWTY6Ecof1746179320.png\" width=\"343\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old man came with complaints of unilateral knee pain. X-ray examination showed reduced joint space. Histopathological examination of the affected joint is shown below. What is the likely diagnosis?", "options": [{"label": "A", "text": "Osteoarthritis", "correct": true}, {"label": "B", "text": "Tuberculosis of the knee", "correct": false}, {"label": "C", "text": "Rheumatoid arthritis", "correct": false}, {"label": "D", "text": "Lyme disease", "correct": false}], "correct_answer": "A. Osteoarthritis", "question_images": ["https://image.prepladder.com/notes/UN0wFwMpJ8lXZ9F9e6fH1746698945.png"], "explanation_images": ["https://image.prepladder.com/notes/UN0wFwMpJ8lXZ9F9e6fH1746698945.png", "https://image.prepladder.com/notes/FiaFsJh2dhBYFgn61Gg01745329643.jpg"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:486px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiological features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Joint space narrowing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Focal areas of loss of <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> cartilage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Osteophytes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bone growth at the joint margins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sclerosis of <span class=\"customMeta\" data-dictid=\"70d8631e3c16927771992f8f444ab1\">subchondral</span> bone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sclerosis of underlying bone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone cysts</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cyst formation in underlying bone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone attrition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Loss of bone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Apparent effusions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Varying degrees of <span class=\"customMeta\" data-dictid=\"d27f9c7a1b16927771999b1679d949\">synovial</span> inflammation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Not visible on radiographs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fibrosis and thickening of the joint capsule</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the current stage of the disease in a patient who presents with hip pain and true shortening of the limb, and is diagnosed with tuberculosis of the hip?", "options": [{"label": "A", "text": "Stage of early arthritis", "correct": false}, {"label": "B", "text": "Stage of synovitis", "correct": false}, {"label": "C", "text": "Stage of advanced arthritis", "correct": true}, {"label": "D", "text": "Stage of arthritis without subluxation", "correct": false}], "correct_answer": "C. Stage of advanced arthritis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/PzXwYZwhd8vdVVLiEZ3B1747907994.png"], "explanation": "<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>X-ray findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage I: Synovitis</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Irritable hip</li>\n<li>Increased FABER (Flexion, Abduction, External Rotation)</li>\n<li>Apparent lengthening due to <strong>FABER</strong> (Position of ease due to synovitis)</li>\n<li>Terminal movements are restricted by 25%</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or haziness of the <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> margins</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage II: Early Arthritis</strong></p>\n<p><strong>(Option B)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Early joint pain, stiffness</li>\n<li>Increased <strong>FADIR</strong> (Flexion, Adduction, Internal Rotation)</li>\n<li>Apparent shortening due to FADIR</li>\n<li>Gluteal and Quadriceps muscle wasting</li>\n<li>ROM restricted by 50%</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Osteopenia and narrowing of joint space</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage III: Late Arthritis</strong></p>\n<p><strong>(Option C)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Marked <strong>FADIR</strong></li>\n<li><strong>True shortening</strong></li>\n<li><strong>Gross restriction of movements </strong>(usually &gt;50%)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Marked <span class=\"customMeta\" data-dictid=\"70d8631e3c16927771992f8f444ab1\">subchondral</span> <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> and destruction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage IV: Pathological Dislocation</strong></p>\n<p><strong>/severe arthritis</strong></p>\n<p><strong>(Option D)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Marked<strong> FADIR</strong></li>\n<li>Gross shortening</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe destruction and loss of joint space</li>\n<li>\"<strong>Wandering/traveling Acetabulum</strong>\": Pathological dislocation/subluxation due to gross destruction of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head or the superior acetabular margin.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Oztürkmen, Yusuf &amp; Karamehmetoğlu, Mahmut &amp; Leblebici, Cem &amp; Gokce, Alper &amp; Caniklioğlu, Mustafa.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/a-This-radiograph-demonstrates-a-travelling-acetabulum-of-the-hipThe-femoral-head-is_fig3_26841474\" data-tags=\"\" height=\"589\" src=\"https://image.prepladder.com/content/PzXwYZwhd8vdVVLiEZ3B1747907994.png\" width=\"1000\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 67-year-old diabetic patient presented with swelling around the knee, restriction of movement and minimal or no pain. The x-ray of the knee is given below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Rheumatoid arthropathy", "correct": false}, {"label": "B", "text": "Osteoarthritis", "correct": false}, {"label": "C", "text": "Charcot arthropathy", "correct": true}, {"label": "D", "text": "Psoriatic arthropathy", "correct": false}], "correct_answer": "C. Charcot arthropathy", "question_images": ["https://image.prepladder.com/content/7gvhwo5HUzUSnRCwcGUa1747908126.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Common Joint Involved</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Diabetes mellitus (Most common cause) (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Peripheral <span class=\"customMeta\" data-dictid=\"2d9476094c16927771933bcb162f19\">neuropathy</span> leads to altered pain sensation and proprioception</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Foot</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Syphilis (Tabes dorsalis)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Neurological deficits affecting joint function</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Knee</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Syringomyelia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Dilatation of the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord; may lead to <span class=\"customMeta\" data-dictid=\"4eac1cd2f016927771990c099e203d\">syringobulbia</span> (if it extends to the Brainstem)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Shoulder</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Leprosy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Neuropathy leading to loss of sensation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Hand and Foot</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Meningomyelocele</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Neurological deficits impacting joint function</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Variable, but often lower limbs</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Diagnosis of Gout is confirmed by which test?", "options": [{"label": "A", "text": "Serum uric acid level", "correct": false}, {"label": "B", "text": "Synovial fluid analysis", "correct": true}, {"label": "C", "text": "Urine uric acid levels", "correct": false}, {"label": "D", "text": "X-ray changes", "correct": false}], "correct_answer": "B. Synovial fluid analysis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 20-year-old male patient who has been experiencing lower backache and morning stiffness for two years, along with bilateral heel pain for the past six months?", "options": [{"label": "A", "text": "Tuberculosis of the spine", "correct": false}, {"label": "B", "text": "Ankylosing spondylitis", "correct": true}, {"label": "C", "text": "Disc prolapse", "correct": false}, {"label": "D", "text": "Mechanical pain", "correct": false}], "correct_answer": "B. Ankylosing spondylitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/dT3Dlav3TZBgvdRf6XFW1745392147.png", "https://image.prepladder.com/notes/1VjPOmAl9ZtHztRlOhIV1746427586.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> disease primarily affecting the <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> <span class=\"customMeta\" data-dictid=\"70f596ae8f16927771983211d9e56f\">skeleton</span> (spine and <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joints), leading to pain, stiffness, and <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> fusion<strong> (bamboo spine)</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Idiopathic; genetic (HLA-B27) and environmental factors involved. HLA-B27 is positive in 90% of cases, but not all carriers develop AS.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inflammation at entheses → Erosive changes → New bone formation → Syndesmophytes → <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">Spinal</span> <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> (ankylosis).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Musculoskeletal Symptoms:</strong></p>\n<ul>\n<li>Chronic low back pain (worse after inactivity, better with activity)</li>\n<li>Limited <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> mobility</li>\n<li>Enthesitis (Achilles, <span class=\"customMeta\" data-dictid=\"a7a430f3a9169277719510c13f434d\">plantar</span> fascia)</li>\n<li>Peripheral <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> (hips, shoulders, knees)</li>\n</ul>\n<p><strong>Extra-articular Symptoms:</strong></p>\n<ul>\n<li><strong>Ocular:</strong> Anterior <span class=\"customMeta\" data-dictid=\"b07d6fd6ef1692777201015472cd79\">uveitis</span> (pain, redness, photophobia)</li>\n<li><strong>Cardiovascular:</strong> Aortic regurgitation, <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> issues</li>\n<li><strong>Pulmonary: </strong>Apical fibrosis</li>\n<li><strong>Gastrointestinal:</strong> Associated with IBD</li>\n</ul>\n<p><strong>Clinical tests:</strong></p>\n<ul>\n<li><strong>Schober/ Modified Schober test (for <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> spine)</strong></li>\n<li>Gaenslen’s test</li>\n<li>Patrick/FABER test</li>\n<li>Figure of 4 test</li>\n<li>Pump handle test</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Based on clinical features, <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> studies, and HLA-B27 gene presence. <strong>Modified New York Criteria:</strong></p>\n<p><strong>Clinical Criteria:</strong></p>\n<ul>\n<li>Low back pain &gt; 3 months (improves with exercise, not with rest)</li>\n<li>Limited <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> spine motion (sagittal/frontal planes)</li>\n<li>Reduced chest expansion (relative to age/sex)</li>\n</ul>\n<p><strong>Radiographic Criteria (X-ray):</strong></p>\n<ul>\n<li>Bilateral <span class=\"customMeta\" data-dictid=\"d17a3a17bc16927771988d9f2533a8\">sacroiliitis</span> (grade 2-4) or <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> <span class=\"customMeta\" data-dictid=\"d17a3a17bc16927771988d9f2533a8\">sacroiliitis</span> (grade 3-4)</li>\n</ul>\n<p><strong>Radiological Features:</strong></p>\n<ul>\n<li>Blurring/haziness of <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joint</li>\n<li>Squaring of vertebrae</li>\n<li><strong>Bamboo spine</strong></li>\n<li><strong>Dagger sign</strong></li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"377\" src=\"https://image.prepladder.com/content/dT3Dlav3TZBgvdRf6XFW1745392147.png\" width=\"377\"/></p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Bamboo Spine vs Dagger Spine\" data-author=\"Lara Sammut, N.Bonanno, R.Grech, A.Mizzi\" data-hash=\"11711\" data-license=\"NA\" data-source=\"https://www.semanticscholar.org/paper/Cornered!-A-pictorial-review-of-the-radiological-in-Sammut-Bonanno/1c9e557c1a500c3ed3e202e5c15b0e4bc7e5db29/figure/4\" data-tags=\"AlkalylosingSpondylosis,SpineAbnormalities\" height=\"378\" src=\"https://image.prepladder.com/notes/1VjPOmAl9ZtHztRlOhIV1746427586.png\" width=\"378\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>MRI:</strong> Early <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> of inflammation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laboratory Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>HLA-B27 positive (90% of cases)</li>\n<li>ESR, CRP: Elevated during active disease, but can be normal</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Pharmacological:</strong></p>\n<ul>\n<li>Physical therapy (mobility/posture exercises)</li>\n<li>Patient education on disease and exercise importance</li>\n</ul>\n<p><strong>Pharmacological:</strong></p>\n<ul>\n<li>NSAIDs (first-line for pain, stiffness)</li>\n<li>TNF inhibitors/IL-17 inhibitors (Secukinumab)</li>\n<li>Sulfasalazine (for <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> arthritis)</li>\n<li>Corticosteroids (short-term <span class=\"customMeta\" data-dictid=\"68e7440bd91692777202d8a14c33e0\">flare</span> control)</li>\n</ul>\n<p><strong>Surgical:</strong></p>\n<ul>\n<li>Hip replacement (for severe hip involvement)</li>\n<li>Spinal surgery (for severe deformities/fractures)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Spinal fractures (minimal trauma)</li>\n<li>Cardiac issues (aortic regurgitation, <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> defects)</li>\n<li>Osteoporosis leading to <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> risk</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with pain in the hand. The joints involved were proximal interphalangeal (PIP) joint, distal interphalangeal (DIP) joint and first carpometacarpal joint. The wrist and metacarpophalangeal (MCP) joints were spared. What is the likely diagnosis?", "options": [{"label": "A", "text": "Osteoarthritis", "correct": true}, {"label": "B", "text": "Rheumatoid arthritis", "correct": false}, {"label": "C", "text": "Psoriatic arthritis", "correct": false}, {"label": "D", "text": "Pseudogout", "correct": false}], "correct_answer": "A. Osteoarthritis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Joint involved &amp; characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Joint spared</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Osteoarthritis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Proximal and <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">Distal</span> <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joints (PIP and DIP), 1st <span class=\"customMeta\" data-dictid=\"3787fbc7ad1692777183a3b034298d\">Carpometacarpal</span> joint, Hip and knee</li>\n<li>Asymmetrical involvement</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Wrist and <span class=\"customMeta\" data-dictid=\"d7e158e089169277719265674b2879\">Metacarpophalangeal</span> (MCP) joints</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rheumatoid arthritis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Metacarpophalangeal joint (MCP) - most commonly involved</li>\n<li>Symmetrical involvement seen</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Distal <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joints (DIP) and 1st <span class=\"customMeta\" data-dictid=\"3787fbc7ad1692777183a3b034298d\">carpometacarpal</span> (CMP) joint</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Psoriatic arthritis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Proximal and <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">Distal</span> <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joints (PIP and DIP)</li>\n<li>Pencil-in-cup, telescoping of digits, <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> mutilans</li>\n<li>Skin and nail involvement +</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ray pattern distribution of joints seen</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which joints are affected in a condition where the distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints are involved, while the metacarpophalangeal (MCP) joints and wrist are spared?", "options": [{"label": "A", "text": "Osteoarthritis", "correct": true}, {"label": "B", "text": "Rheumatoid arthritis", "correct": false}, {"label": "C", "text": "Psoriasis", "correct": false}, {"label": "D", "text": "Hyperparathyroidism", "correct": false}], "correct_answer": "A. Osteoarthritis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/GMFhtIZcOzN5NQNjOO7w1746706226.png", "https://image.prepladder.com/content/HxUnNFMbwuapuxcDvpf91746706226.png", "https://image.prepladder.com/content/65QI5t8jtqmSBY6N2FJu1746706226.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Diagnosis of Gout is confirmed by which test?", "options": [{"label": "A", "text": "Serum uric acid level", "correct": false}, {"label": "B", "text": "Synovial fluid analysis", "correct": true}, {"label": "C", "text": "Urine uric acid levels", "correct": false}, {"label": "D", "text": "X- ray changes", "correct": false}], "correct_answer": "B. Synovial fluid analysis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Synovial Fluid A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statement about septic arthritis is true", "options": [{"label": "A", "text": "Staph aureus is most common organism in adults", "correct": false}, {"label": "B", "text": "Incision and drainage done after culture of aspirate and antibiotic for 24 hours", "correct": true}, {"label": "C", "text": "Kocher’s criteria is used to differentiate from transient synovitis", "correct": false}, {"label": "D", "text": "Widening of joint space is seen", "correct": false}], "correct_answer": "B. Incision and drainage done after culture of aspirate and antibiotic for 24 hours", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Incision and &lt;span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\"&gt;drainage&lt;/span&gt; done after culture of &lt;span class=\"customMeta\" data-dictid=\"a246c8382816927771821a267ea486\"&gt;aspirate&lt;/span&gt; and &lt;span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\"&gt;antibiotic&lt;/span&gt; for 24 hou\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How to manage a patient of Rheumatoid arthritis with deformity?", "options": [{"label": "A", "text": "Steroids", "correct": false}, {"label": "B", "text": "Methotrexate with steroids", "correct": false}, {"label": "C", "text": "Methotrexate with anti-TNF", "correct": true}, {"label": "D", "text": "Steroids only after NSAlDs fail", "correct": false}], "correct_answer": "C. Methotrexate with anti-TNF", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Methotrexate with anti-TNF\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which joints are affected in a condition where the distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints are involved, while the metacarpophalangeal (MCP) joints and wrist are spared?", "options": [{"label": "A", "text": "Osteoarthritis", "correct": true}, {"label": "B", "text": "Rheumatoid arthritis", "correct": false}, {"label": "C", "text": "Psoriasis", "correct": false}, {"label": "D", "text": "Hyperparathyroidism", "correct": false}], "correct_answer": "A. Osteoarthritis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Osteoarth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most specific for ankylosing spondylitis?", "options": [{"label": "A", "text": "HLA B37", "correct": false}, {"label": "B", "text": "Costovertebral and costosternal ankylosis may cause restrictive lung disease", "correct": true}, {"label": "C", "text": "More common in Females", "correct": false}, {"label": "D", "text": "Vertebral Expansion", "correct": false}], "correct_answer": "B. Costovertebral and costosternal ankylosis may cause restrictive lung disease", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/veEWF2gzWUYqtDbxZSH91700213195.png"], "explanation": "<p>Correct Option B &lt;span class=\"marker\"&gt;- &lt;/span&g\n<table>\n<tbody>\n<tr>\n<td>Definition</td>\n<td>Ankylosing <span class=\"customMeta\" data-dictid=\"42d4868c2e1692777199353a7ad077\">spondylitis</span> (AS) is a chronic <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> that primarily affects the spine and <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joints, causing pain, stiffness, and potential <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> of the vertebrae.</td>\n</tr>\n<tr>\n<td>Onset</td>\n<td>Usually begins in late <span class=\"customMeta\" data-dictid=\"98d9739e5f1692777180d7de404750\">adolescence</span> or early adulthood, with a peak onset between the ages of 17 and 45.</td>\n</tr>\n<tr>\n<td>Symptoms</td>\n<td><strong>Early Symptoms:</strong> Lower back pain and stiffness. <strong>Later Symptoms:</strong> <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">Spinal</span> fusion, limited mobility, fatigue, and <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> joint involvement.</td>\n</tr>\n<tr>\n<td>HLA-B27</td>\n<td>Genetic marker often associated with ankylosing spondylitis; however, its presence does not confirm the diagnosis, and not all individuals with AS have this marker.</td>\n</tr>\n<tr>\n<td>Imaging</td>\n<td>\n<p>X-rays and <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> may be used to assess inflammation, joint damage, and the <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> of <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> fusion.</p>\n<p>Bamboo spine on Xray<br/>\n<img src=\"https://image.prepladder.com/content/veEWF2gzWUYqtDbxZSH91700213195.png\" style=\"height:413px; width:333px\"/></p>\n</td>\n</tr>\n<tr>\n<td>Disease Progression</td>\n<td>Ankylosing <span class=\"customMeta\" data-dictid=\"42d4868c2e1692777199353a7ad077\">spondylitis</span> can lead to the formation of new bone, causing the spine to <span class=\"customMeta\" data-dictid=\"30bdb5481f1692777203cbadf50a71\">fuse</span> in a fixed, forward-bent position.</td>\n</tr>\n<tr>\n<td>Extra-Articular Manifestations</td>\n<td>In addition to <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> and <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joint involvement, AS may affect other joints, eyes (uveitis), skin, and organs, leading to various complications.</td>\n</tr>\n<tr>\n<td>Treatment</td>\n<td><strong>Medications:</strong> Nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying <span class=\"customMeta\" data-dictid=\"fc3fc706581692777181d901117e4a\">antirheumatic</span> drugs (DMARDs), biologics. <strong>Physical Therapy:</strong> Exercises to maintain flexibility and posture. <strong>Surgery:</strong> Rarely needed, may be considered for severe joint damage or <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> deformity.</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common form of arthritis?", "options": [{"label": "A", "text": "Rheumatoid arthritis", "correct": false}, {"label": "B", "text": "Psoriatic arthritis", "correct": false}, {"label": "C", "text": "Seronegative arthritis", "correct": false}, {"label": "D", "text": "Osteoarthritis", "correct": true}], "correct_answer": "D. Osteoarthritis", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 25 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 27</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Bone Infections-Bone And Joint Infections - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 27</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. 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Radiological imaging shows a bone cavity with thickened cortices. What is the cornerstone of treatment in this patient?", "options": [{"label": "A", "text": "Long-term antibiotic therapy", "correct": false}, {"label": "B", "text": "Sequestrectomy &amp;amp; Saucerisation", "correct": true}, {"label": "C", "text": "Observation and wound care", "correct": false}, {"label": "D", "text": "Radiation therapy", "correct": false}], "correct_answer": "B. Sequestrectomy &amp; Saucerisation", "question_images": ["https://image.prepladder.com/content/Lp0pjI3CAllgaoT7nzir1737953728.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment of Chronic Osteomyelitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Intervention</strong></p>\n<p><strong>(Option B)</strong></p>\n<br/>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><u>Sequestrectomy</u>: Removal of dead bone (sequestrum) to eliminate the source of infection.</li>\n<li><u>Saucerisation</u>: Reshaping the bone <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> to prevent <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> accumulation and promote drainage.</li>\n<li><u>Curettage</u>: Scraping infected tissue from the bone cavity, followed by <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> with <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> beads or muscle flaps.</li>\n<li><u>Excision of Infected Bone</u>: Complete removal of severely infected bone segments, if feasible.</li>\n<li><u>Bone Transport (Ilizarov Technique)</u>: Used to regenerate bone after <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> of infected segments.</li>\n<li><u>Soft Tissue Coverage</u>: Skin grafts or flaps to cover exposed bone, are essential for healing.</li>\n<li><u>Vaccum-assisted covering(Negative pressure wound therapy):</u> Promotes <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue formation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antibiotic Therapy</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Antibiotics help control infection but are ineffective alone without surgery.</li>\n<li>Antibiotics are chosen based on the specific bacteria identified in cultures. Eg. <strong>Fusidic acid</strong><strong>,</strong> <span class=\"customMeta\" data-dictid=\"1d8d8a391016927771843f2f1c40b9\">clindamycin</span> and cephalosporins.</li>\n<li>Typically involves 4-6 weeks of <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> antibiotics, followed by oral therapy for 3-6 weeks.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Post-Treatment Care</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Regular follow-up to detect any recurrence.</li>\n<li>Avoid trauma to the affected area to prevent reactivation.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/JHRT9Qixdb1fbSSms8t11745756068.mp3", "video": ""}, {"text": "A 6 y/o boy presents with a 2-day history of a painful limp. He has mild pain referred to the thigh and a low-grade fever of 37.5°C. O/E, he shows limited internal rotation of the hip and is unable to bear full weight, but remains otherwise well. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Septic arthritis", "correct": false}, {"label": "B", "text": "Transient synovitis", "correct": true}, {"label": "C", "text": "Legg-Calvé-Perthes disease", "correct": false}, {"label": "D", "text": "Osteomyelitis", "correct": false}], "correct_answer": "B. Transient synovitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/jVlG9LYuQKksiQ66o0UY1737956188.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/RyYHlvQsjn2kOO4rzrvh1743839687.mp3", "video": ""}, {"text": "Based on the image, identify the structures indicated by the arrows", "options": [{"label": "A", "text": "Yellow: Sequestrum, White: Cloaca, Red: Involucrum", "correct": false}, {"label": "B", "text": "Yellow: Involucrum, White: Sequestrum, Red: Cloaca", "correct": false}, {"label": "C", "text": "Yellow: Cloaca, White: Involucrum, Red: Sequestrum", "correct": false}, {"label": "D", "text": "Yellow: Sequestrum, White: Involucrum, Red: Cloaca", "correct": true}], "correct_answer": "D. Yellow: Sequestrum, White: Involucrum, Red: Cloaca", "question_images": ["https://image.prepladder.com/notes/JHq0PGFgBwb5QKSCIGd21743855608.png"], "explanation_images": ["https://image.prepladder.com/content/V5bj3LqtQIQA1R5YgRMm1737956063.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Sequestrum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Involucrum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cloaca</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Definition</strong>: A piece of dead bone separated from living bone due to infection.</li>\n<li><strong>Formation</strong>: Occurs in neglected cases of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> osteomyelitis, resulting from tissue destruction.</li>\n<li><strong>Characteristics</strong>: Size varies; can range from small spicules to large necrotic segments of the cortex.</li>\n<li><strong>Clinical Significance</strong>: Remains entombed within the bone, inaccessible for destruction or repair.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Definition</strong>: New bone formation around the infected zone.</li>\n<li><strong>Formation</strong>: Develops on <span class=\"customMeta\" data-dictid=\"915ca56f53169277720296a38e3e8e\">viable</span> surfaces in the bone and from the deep layers of the stripped periosteum.</li>\n<li><strong>Characteristics</strong>: Initially porotic, becomes thicker to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> a casing around the <span class=\"customMeta\" data-dictid=\"1cc86ea16516927771984e87bf0c7a\">sequestrum</span> and infected tissue.</li>\n<li><strong>Clinical Significance</strong>: Can help enclose and isolate the infection, but may lead to permanent <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> if <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> is inadequate.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Definition</strong>: Perforations in the <span class=\"customMeta\" data-dictid=\"0ca6db1ee216927771902cda13d61b\">involucrum</span> that allow <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> of <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> and bone debris.</li>\n<li><strong>Formation</strong>: Develops as the infection persists, leading to small openings through which material can escape.</li>\n<li><strong>Characteristics</strong>: Creates a path for the <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> to track through sinuses to the skin surface.</li>\n<li><strong>Clinical Significance</strong>: Indicates the <span class=\"customMeta\" data-dictid=\"379b4c5d5c16927771846e8b122c21\">chronicity</span> of osteomyelitis, leading to <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">intermittent</span> <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> through sinuses.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/UxCvABA5ZvyPyVtpt2c61745317380.mp3", "video": ""}, {"text": "A 23 y/o male presents with wrist pain and stiffness after months of repetitive wrist use in sports. Examination reveals tenderness over the lunate bone. MRI shows ischemic necrosis of the lunate. What is the most likely predisposing factor for this patient’s condition?", "options": [{"label": "A", "text": "Negative ulnar variance", "correct": true}, {"label": "B", "text": "Carpal tunnel syndrome", "correct": false}, {"label": "C", "text": "Rheumatoid arthritis", "correct": false}, {"label": "D", "text": "Fracture of the scaphoid", "correct": false}], "correct_answer": "A. Negative ulnar variance", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cJUFqz2DtTmMvjyjPR241737955982.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ZTS68V4iqcWMxw5uXzUa1743838942.mp3", "video": ""}, {"text": "A 14 y/o male presents with pain and swelling over his tibial tuberosity following physical activity. O/E, there is a tender lump over the tibial tubercle. An X-ray is shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Haas disease", "correct": false}, {"label": "B", "text": "Freiberg disease", "correct": false}, {"label": "C", "text": "Kienböck’s disease", "correct": false}, {"label": "D", "text": "Osgood–Schlatter disease", "correct": true}], "correct_answer": "D. Osgood–Schlatter disease", "question_images": ["https://image.prepladder.com/content/dyrqRoEwaX21ZjcJIWbf1737955125.png"], "explanation_images": ["https://image.prepladder.com/content/m71vcQvXFLXLkuFCjPsd1737955743.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/I5n9vkvoDVpl7YPqfmef1743838814.mp3", "video": ""}, {"text": "A 12-year-old boy presents with anterior knee pain that worsens with activity, particularly while running and jumping. Physical examination reveals tenderness at the inferior pole of the patella, and X-rays show no significant abnormalities. Which of the following conditions is most likely diagnosed in this patient?", "options": [{"label": "A", "text": "Osgood-Schlatter disease", "correct": false}, {"label": "B", "text": "Sinding-Larsen-Johansson syndrome", "correct": true}, {"label": "C", "text": "Sever's disease", "correct": false}, {"label": "D", "text": "Perthes disease", "correct": false}], "correct_answer": "B. Sinding-Larsen-Johansson syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/LYPb1kJMozort0OZUItQ1737954817.png", "https://image.prepladder.com/content/QOgNh4qrZq6EfbZOKlEz1737954845.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Various osteochondritis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location of osteochondritis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sinding-Larsen-Johansson</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Patella</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1498\" src=\"https://image.prepladder.com/content/LYPb1kJMozort0OZUItQ1737954817.png\" width=\"1999\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Osgood-Schlatter </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tibial tuberosity</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/QOgNh4qrZq6EfbZOKlEz1737954845.png\" width=\"1576\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sever </strong><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Calcaneum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hawkins</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Talus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Freiberg</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2nd Metatarsal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Islene</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5th Metatarsal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Haas</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Head of Humerus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Panner</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Capitulum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Preiser</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> pole of the scaphoid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Keinbock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lunate</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Friedrich’s</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clavicle</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Scheuermann</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rim of the vertebral body</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Calve’s</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Centre of the vertebral body</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Perthes disease (Legg-calve’s-Perthes disease)</strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Head of Femur</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zWjDx24bUdxHsEcVqftl1743838569.mp3", "video": ""}, {"text": "A 10 y/o girl with Gaucher's disease presents with worsening hip pain and limited range of motion. Imaging shows avascular necrosis of the femoral head. Which of the following clinical features is most likely to accompany her diagnosis?", "options": [{"label": "A", "text": "Elevated serum calcium levels", "correct": false}, {"label": "B", "text": "Anemia and thrombocytopenia", "correct": true}, {"label": "C", "text": "Hyperuricemia", "correct": false}, {"label": "D", "text": "Increased bone density on X-ray", "correct": false}], "correct_answer": "B. Anemia and thrombocytopenia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/VS5uOVklBgLSXw5Wko2R1737954741.png"], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Reference:</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/CSOJqhfacJGoVpkFRaM41743838423.mp3", "video": ""}, {"text": "A 45-year-old male patient presents with hip pain and limited mobility. MRI findings suggest early resorptive changes, but X-rays appear normal. According to Ficat and Arlet staging, what is the most likely stage of avascular necrosis (AVN) for this patient?", "options": [{"label": "A", "text": "Stage 0", "correct": false}, {"label": "B", "text": "Stage 1", "correct": true}, {"label": "C", "text": "Stage 2", "correct": false}, {"label": "D", "text": "Stage 3", "correct": false}], "correct_answer": "B. Stage 1", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Reference:</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage 0</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Preclinical and preradiological, <span class=\"customMeta\" data-dictid=\"4ec110bc6e1692777182a193acd863\">AVN</span> is suggested only if diagnosed in another area (e.g., opposite hip).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Early resorptive phase; <span class=\"customMeta\" data-dictid=\"6fda63a90c1692777202563d33a81b\">X-rays</span> normal, but changes seen on <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> or bone scintigraphy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage 2</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reparative stage with normal <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head contour; early signs of <span class=\"customMeta\" data-dictid=\"092583d1b41692777197a506409267\">reactive</span> <span class=\"customMeta\" data-dictid=\"70d8631e3c16927771992f8f444ab1\">subchondral</span> changes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage 3</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The early collapse of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head with clear <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> signs of osteonecrosis, structural damage, and bone outline distortion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage 4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Collapse of the <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> surface with secondary <span class=\"customMeta\" data-dictid=\"720567fecd169277719411dda3d1a2\">osteoarthritis</span> (OA).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early Stages (0-2)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Watchful waiting for lesions in non-weight-bearing joints.</li>\n<li>Drug therapy (e.g., bisphosphonates, statins) may help.</li>\n<li>Medullary <span class=\"customMeta\" data-dictid=\"46a5e63f281692777185d3f56ea186\">decompression</span> and bone <span class=\"customMeta\" data-dictid=\"6ca773c032169277718858b8ad1e9c\">grafting</span> for <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head necrosis.</li>\n<li>Unloading <span class=\"customMeta\" data-dictid=\"d1ed4aacdf1692777194c9aa2fc2ac\">osteotomy</span> to preserve <span class=\"customMeta\" data-dictid=\"9e99effc421692777181b02606e021\">anatomy</span> in weight-bearing joints.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intermediate Stage (3)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Realignment <span class=\"customMeta\" data-dictid=\"d1ed4aacdf1692777194c9aa2fc2ac\">osteotomy</span> with/without <span class=\"customMeta\" data-dictid=\"f857ee35331692777185a5895e53b5\">curettage</span> and bone <span class=\"customMeta\" data-dictid=\"6ca773c032169277718858b8ad1e9c\">grafting</span> of the necrotic segment.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Late Stage (4)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Non-operative management: pain control, activity modification.</li>\n<li>Arthrodesis for stability (e.g., ankle, wrist).</li>\n<li>Joint replacement (hip, knee, shoulder).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/kz9NRUu9xjnqV9WZ5AZo1743772037.mp3", "video": ""}, {"text": "A 28 y/o woman presents with persistent knee pain after recently undergoing bariatric surgery. She reports a history of significant weight loss and intermittent joint swelling. MRI was taken which revealed the following. What is the most likely reason behind this patient's condition?", "options": [{"label": "A", "text": "Postoperative autoimmune response leading to synovitis", "correct": false}, {"label": "B", "text": "Fat embolism from rapid adipose tissue breakdown", "correct": true}, {"label": "C", "text": "Osteoporosis due to nutritional deficiencies", "correct": false}, {"label": "D", "text": "Bed rest post surgery", "correct": false}], "correct_answer": "B. Fat embolism from rapid adipose tissue breakdown", "question_images": ["https://image.prepladder.com/content/uReP9Sg7GsgXYH6gNYhF1737954621.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:635px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Causes of Osteonecrosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Trauma:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fractures or dislocations disrupt blood supply, especially in the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> neck, scaphoid, and talus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Corticosteroid Use:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High-dose steroids cause fat cell <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> and <span class=\"customMeta\" data-dictid=\"837d6227d81692777190a063ea2cd4\">intravascular</span> stasis, leading to bone ischemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alcohol Abuse:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic alcohol use leads to fat <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> and <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> swelling, causing <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> stasis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sickle Cell Disease:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sickled red cells obstruct blood vessels, leading to <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> and bone death.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gaucher’s Disease:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lipid accumulation in <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> causes <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> and ischemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thrombophilia:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased blood <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> tendency leads to <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> thrombosis, causing bone necrosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antiphospholipid Antibodies:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>As seen in SLE, these antibodies promote <span class=\"customMeta\" data-dictid=\"5e0b40993316927771844dbf382689\">clot</span> formation, leading to ischemia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fat Embolism:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fat <span class=\"customMeta\" data-dictid=\"586c1eff6e16927771872ba5871abe\">emboli</span> block capillaries, causing endothelial damage and thrombosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Venous Stasis:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Marrow <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> increases <span class=\"customMeta\" data-dictid=\"6a346f84561692777190430904e7b3\">intraosseous</span> pressure, leading to <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"43c30dc8c8169277718317ffb7dea0\">blockage</span> and ischemia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dysbaric Osteonecrosis:</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid <span class=\"customMeta\" data-dictid=\"46a5e63f281692777185d3f56ea186\">decompression</span> (e.g., in divers) causes gas bubbles in vessels, leading to bone necrosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pregnancy:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hormonal changes and <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> liver can decrease fibrinolysis, increasing <span class=\"customMeta\" data-dictid=\"5e0b40993316927771844dbf382689\">clot</span> formation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiation Exposure:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radiation damages blood vessels, leading to poor <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> and bone necrosis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/BDZgrR6qvep67UeGitaY1743771839.mp3", "video": ""}, {"text": "A 40 y/o man presents with severe knee pain and swelling after drinking contaminated water from a stepwell in Rajasthan. Upon examination, a painful inflamed lesion with a visible adult worm is noted on his leg. Which of the following is the primary method for diagnosing the patient's condition?", "options": [{"label": "A", "text": "X-ray imaging of the knee", "correct": false}, {"label": "B", "text": "Visual inspection of the lesion", "correct": true}, {"label": "C", "text": "MRI of the affected joint", "correct": false}, {"label": "D", "text": "Joint aspiration for synovial fluid analysis", "correct": false}], "correct_answer": "B. Visual inspection of the lesion", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/rorx5y1UnH4C64MEKOzC1737954498.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Smallpox <span class=\"customMeta\" data-dictid=\"f7bd04046e16927771943526af1e35\">Osteomyelitis</span> (Osteomyelitis Variolosa)</strong></h3>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Guinea <span class=\"customMeta\" data-dictid=\"cc08235a711692777202fabc5d7cdb\">Worm</span> Arthritis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Cause:</strong> <span class=\"customMeta\" data-dictid=\"2624f247591692777194d9c4d03cd7\">Osteoarticular</span> involvement from <span class=\"customMeta\" data-dictid=\"79abf2d9eb1692777201fafa22ab07\">Variola</span> major virus during childhood <span class=\"customMeta\" data-dictid=\"9c1a0ed00916927771986d03319405\">smallpox</span> infection.</li>\n<li><strong>Affected Areas:</strong> <span class=\"customMeta\" data-dictid=\"d963da62eb16927771993737a99c7c\">Symmetrical</span> involvement, primarily in elbows (80%), wrists, ankles, hands, and feet; spine and <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> are rarely involved.</li>\n<li><strong>Symptoms:</strong> Gradual <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> of joints, leading to bone deformities and joint instability.</li>\n<li><strong>Diagnosis-</strong>\n<ul>\n<li><strong>Clinical Examination: </strong>Detection of bilateral, <span class=\"customMeta\" data-dictid=\"d963da62eb16927771993737a99c7c\">symmetrical</span> joint deformities</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Treatment: Self-limiting-</strong> The condition cannot be prevented or repaired.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Seen <span class=\"customMeta\" data-dictid=\"59c8c1e4b316927771873c98afae15\">endemic</span> in Rajasthan, due to the use of stepwells.</li>\n<li><strong>Cause:</strong> Infection with <span class=\"customMeta\" data-dictid=\"06949762821692777186b99cb666d9\">Dracunculus</span> medinensis from drinking water containing infected copepods.</li>\n<li><strong>Symptoms:</strong> Painful, inflamed skin <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> containing an adult worm.</li>\n<li><strong>Diagnosis:</strong> Visual inspection of the lesion; calcified worms can be detected via X-ray.</li>\n<li><strong>Treatment:</strong> Slow, careful removal of the adult worm.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Vb9P5A5iPQlqHivLfiSL1743771705.mp3", "video": ""}, {"text": "A 10-month-old infant presents with a fever of 102°F, irritability, and refusal to bear weight on the right leg. Physical examination reveals tenderness and swelling around the right hip joint. An ultrasound shows significant joint effusion. What is the most likely diagnosis for this patient?", "options": [{"label": "A", "text": "Reactive arthritis", "correct": false}, {"label": "B", "text": "Tom Smith Arthritis (TSA)", "correct": true}, {"label": "C", "text": "Transient synovitis", "correct": false}, {"label": "D", "text": "Developmental Dysplasia of the Hip (DDH)", "correct": false}], "correct_answer": "B. Tom Smith Arthritis (TSA)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/RkX9Hygp20QmZJZVsNBT1737954386.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/14RZOpr5LvTLCR17Yken1743771441.mp3", "video": ""}, {"text": "A 2-month-old infant is brought to the pediatric clinic due to poor feeding and lethargy. On examination, the physician notes a diffuse rash, hepatosplenomegaly, and a swollen left knee joint, indicating early congenital syphilis. Which of the following findings can be seen in early congenital syphilis?", "options": [{"label": "A", "text": "Hutchinson's teeth", "correct": false}, {"label": "B", "text": "Sabre tibia", "correct": false}, {"label": "C", "text": "Parrot's joint", "correct": true}, {"label": "D", "text": "Neuropathic joint destruction", "correct": false}], "correct_answer": "C. Parrot's joint", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wT1kmzLEaKGIzWHl9ZT11737953955.png", "https://image.prepladder.com/content/bK4zeTRcWvMrgQGHYXiB1737954325.png", "https://image.prepladder.com/content/G80Hcg9b5pc6dyqihvDK1737954274.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:675px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Congenital syphilis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acquired syphilis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Cause</strong>: <span class=\"customMeta\" data-dictid=\"32583099e91692777200c34d388c09\">Transplacental</span> transmission during pregnancy.</li>\n<li><strong><u>Early <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> syphilis</u></strong><u>:</u>\n<ul>\n<li>Diagnosed from birth through 2 years of age</li>\n<li><strong>Parrot’s Syphilitic Joint</strong><strong>: </strong>congenital <span class=\"customMeta\" data-dictid=\"23f8d40f6a1692777199029dbec026\">syphilis</span> <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> with <span class=\"customMeta\" data-dictid=\"fcc7c475d216927771955c30d101c2\">periostitis</span> and pain.Leads to joint effusion, epiphysitis, and limited movement.</li>\n<li><strong>X-rays</strong>: <span class=\"customMeta\" data-dictid=\"de2ba822ec1692777194ed5101de89\">Osteochondritis</span> (lucent bands near physis), <span class=\"customMeta\" data-dictid=\"fcc7c475d216927771955c30d101c2\">periostitis</span> (mild or ‘onion-peel’ effect).</li>\n</ul>\n</li>\n<li><strong><u>Late <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> syphilis</u></strong><u>:</u>\n<ul>\n<li>Diagnosed after 2 years of birth</li>\n<li><strong>Features</strong>: <span class=\"customMeta\" data-dictid=\"f6652e19ca169277718885c47ffc9b\">Gummata</span> and other bone lesions</li>\n<li><strong>Sabre tibia</strong>-the <a href=\"https://www.osmosis.org/learn/Bones_of_the_lower_limb\">tibial</a> bone has a pronounced <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> bowing (i.e., <span class=\"customMeta\" data-dictid=\"247e7aa0181692777182e46b52832d\">bends</span> forward)<strong>(Option B ruled out)</strong></li>\n<li><strong>Hutchinson’s teeth</strong> <strong>(Option A ruled out)</strong>- abnormal. Notched teeth</li>\n<li><strong>Clutton’s joints</strong> - Painless <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> in elbows and knees.</li>\n<li><strong>Parrot's sign</strong>, or 'Parrot's nodes'/'Parrot's bosses,' refers to bony growths observed on the skulls of children with <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> syphilis.</li>\n<li><strong>Higoumenakis' sign</strong> refers to the <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> of the sternal end of the right clavicle</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong><u>Early <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">acquired</span> syphilis</u></strong>:\n\t\t\t\t<ul>\n<li><u>Painful/tender bones:</u> <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">Frontal</span> skull bones, tibia, sternum, ribs.</li>\n<li><u>X-rays: </u>Periostitis, thickened cortex</li>\n<li><strong>Hydrarthrosis</strong>:</li>\n</ul>\n</li>\n<li><strong><u>Late <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">acquired</span> syphilis</u></strong>:\n\t\t\t\t<ul>\n<li><u>Syphilitic gumma:</u> <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">Granulomatous</span> lesions with bone resorption, sclerosis.</li>\n<li><u>Charcot’s Joint</u>: Nerve damage leads to loss of sensation in the joint, most commonly affecting the foot and ankle. <strong>(Option D ruled out)</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/JqOAiRAkJZAO7NFsXutQ1743771331.mp3", "video": ""}, {"text": "A 35-year-old milkman presents with a three-week history of fluctuating low-grade fevers, drenching night sweats, and severe lower back pain. He reports increasing discomfort in his hips and knees, particularly after long days of work. Which of the following is the most likely diagnosis for this patient?", "options": [{"label": "A", "text": "Osteoarthritis", "correct": false}, {"label": "B", "text": "Tuberculosis osteomyelitis", "correct": false}, {"label": "C", "text": "Brucellar osteomyelitis", "correct": true}, {"label": "D", "text": "Rheumatoid arthritis", "correct": false}], "correct_answer": "C. Brucellar osteomyelitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/bF5DFG6eLHRhyCaMFeqN1737953871.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:607px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Caused by <strong>Brucella melitensis, <span class=\"customMeta\" data-dictid=\"1ce278e02d1692777183655ea881dc\">Brucella</span> <span class=\"customMeta\" data-dictid=\"08b6873cdf16927771808060833cc5\">abortus</span> (cattle), </strong>and <strong>Brucella suis</strong> (pigs).</li>\n<li>Transmission via unpasteurized milk or contact with infected meat (farmers, meat handlers).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Entry through<strong> infected milk, skin, or mucosal surfaces</strong>.</li>\n<li>Spreads via lymphatics and <span class=\"customMeta\" data-dictid=\"a813884d6016927771838d2d1f9d1d\">bloodstream</span> to bones (often vertebral bodies) or synovium.</li>\n<li>Granulomatous inflammation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Sacroiliac</strong> and <strong>spinal joints</strong> are most frequently involved</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Initial symptoms: <span class=\"customMeta\" data-dictid=\"1b5a7ceea716927771815e7283e571\">Alternating</span> fever and improvement phases (<strong>undulant fever</strong>), headache, generalized weakness, joint pains, and backache.</li>\n<li>Joint involvement: Pain, swelling, tenderness, restricted movement (commonly in hip, knee, spine).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Subacute <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> with <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> space loss, bone erosion, and <span class=\"customMeta\" data-dictid=\"b1db3c1e5d1692777195ff7cd3e282\">periarticular</span> osteoporosis.</li>\n<li>Spine: Destruction and collapse of vertebral bodies, disc obliteration</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Antibiotics:</strong> <span class=\"customMeta\" data-dictid=\"8784b5a7ad16927772005323b514b8\">Tetracycline</span> + <span class=\"customMeta\" data-dictid=\"39899c81f016927771991addbc683d\">streptomycin</span> (3–4 weeks)</li>\n<li><strong>Surgery:</strong> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">Drainage</span> of abscess, <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> of necrotic tissue, arthrodesis/arthroplasty if joint destruction occurs.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/DXCbEbIRMQDKM6Hs5zKg1743770746.mp3", "video": ""}, {"text": "A 50 y/o woman with chronic osteomyelitis presents with a draining sinus and increasing pain in her leg. Which of the following is not a potential complication of her condition?", "options": [{"label": "A", "text": "Pathological fracture", "correct": false}, {"label": "B", "text": "Squamous cell carcinoma", "correct": false}, {"label": "C", "text": "Acute exacerbation", "correct": false}, {"label": "D", "text": "Chronic joint pain", "correct": true}], "correct_answer": "D. Chronic joint pain", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/z6hh25T7K9paCWYlXj111743770561.mp3", "video": ""}, {"text": "Which of the following statements about osteomyelitis is true? The most common site for hematogenous spread of infection in adults is the thoracolumbar spine. The most common organism found in patients using intravenous drugs is Salmonella typhi. The most common organism in children aged 1 to 4 years is Haemophilus influenza. The metaphysis of the distal femur and proximal tibia is the most common site of infection in children aged 2 to 6 years. The most common organism in sickle-cell disease is Pseudomonas aeruginosa.", "options": [{"label": "A", "text": "2, 3, 5", "correct": false}, {"label": "B", "text": "1, 3, 4", "correct": true}, {"label": "C", "text": "1, 4, 5", "correct": false}, {"label": "D", "text": "2 and 4 only", "correct": false}], "correct_answer": "B. 1, 3, 4", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/O25yqL6tBzUjdMSYYVe71743583554.mp3", "video": ""}, {"text": "A 50 y/o male presents with a history of recurring pain, fever, and a discharging sinus on his right leg for several months. He reports being treated for osteomyelitis during childhood. Which of the following investigations would be most useful to visualise the extent of soft tissue involvement in this patient?", "options": [{"label": "A", "text": "CT scan", "correct": false}, {"label": "B", "text": "Ultrasound", "correct": false}, {"label": "C", "text": "Magnetic Resonance Imaging (MRI)", "correct": true}, {"label": "D", "text": "Radionuclide Scintigraphy", "correct": false}], "correct_answer": "C. Magnetic Resonance Imaging (MRI)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vQjkNyA5jSueonyzA6dA1737953395.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/YjCDAbWn8EzIqOhPIff71745755932.mp3", "video": ""}, {"text": "What radiological feature distinguishes a sequestrum from living bone in a case of osteomyelitis?", "options": [{"label": "A", "text": "Increased radiolucency", "correct": false}, {"label": "B", "text": "Reduced density", "correct": false}, {"label": "C", "text": "Increased density", "correct": true}, {"label": "D", "text": "Fracture line", "correct": false}], "correct_answer": "C. Increased density", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/HsKhgETr3zEO89MA6zNg1737952644.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/wC1nOafuW9acV5thO19L1743769825.mp3", "video": ""}, {"text": "A 45 y/o man with a history of tuberculosis presents with a chronic draining sinus on his left tibia. Radiographic imaging shows multiple bone lesions with areas of necrosis. Given his medical history and the radiological findings, what type of sequestrum is most likely present?", "options": [{"label": "A", "text": "Tubular", "correct": false}, {"label": "B", "text": "Ring", "correct": false}, {"label": "C", "text": "Coke", "correct": true}, {"label": "D", "text": "Feathery", "correct": false}], "correct_answer": "C. Coke", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/V45qF5XVjC4QHf4lHKjD1737952551.png", "https://image.prepladder.com/content/ZGTyMQjiOn79BNVxOxfS1737952466.png", "https://image.prepladder.com/content/UZM9NzrdrI4T6LdR7OFK1737952417.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:500px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types of Sequestrum</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tubular <strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pyogenic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ring <strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>External Fixator</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Black</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Actinomycosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Coralliform</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Perthe’s Disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Coke (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tuberculosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sandy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tuberculosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Feathery/ <span class=\"customMeta\" data-dictid=\"740e02fb6d16927771903b5f219b2e\">Ivory</span> <strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Syphilis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/WkkhPyj1f8BUg3rbbraK1743766498.mp3", "video": ""}, {"text": "A 38 y/o male presents with chronic pain and intermittent purulent discharge from a sinus over his right tibia, which developed after a fracture sustained 8 months ago. An X-ray shows the following finding. Which of the following is most likely responsible for the persistence of his infection?", "options": [{"label": "A", "text": "Lack of initial antibiotic therapy", "correct": true}, {"label": "B", "text": "Sequestrum formation", "correct": false}, {"label": "C", "text": "Incomplete fracture healing", "correct": false}, {"label": "D", "text": "Soft tissue abscess", "correct": false}], "correct_answer": "A. Lack of initial antibiotic therapy", "question_images": ["https://image.prepladder.com/content/qPrkkWSNIimmkl6H8IK31737952317.png"], "explanation_images": ["https://image.prepladder.com/content/ha7eldF4ISkn7dWlppFn1737952292.png", "https://image.prepladder.com/content/hasDiREX1rYV6y3NQefU1737952189.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/SuKPQ0mXZiutTCplMCG11743766286.mp3", "video": ""}, {"text": "A 45-year-old male with a history of an open tibial fracture 2 years ago presents with intermittent pain, redness, and a discharging sinus at the injury site for the past 2 months. He has occasional low-grade fever and tenderness with scarring on examination. X-ray shows cortical thickening and bone deformity. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Acute osteomyelitis", "correct": false}, {"label": "B", "text": "Ewing’s sarcoma", "correct": false}, {"label": "C", "text": "Chronic osteomyelitis", "correct": true}, {"label": "D", "text": "Osteoid osteoma", "correct": false}], "correct_answer": "C. Chronic osteomyelitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/TiKfnoYGdK0CsG7nFESt1737952139.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/xi7ilB6NGP1Zj4lRVKUL1743765017.mp3", "video": ""}, {"text": "A 16-year-old male has had dull, aching pain in his right tibia for 6 months, with intermittent swelling and mild fever. X-ray shows cortical thickening and increased bone density. Biopsy reveals no abscess, and cultures are negative. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Ewing’s sarcoma", "correct": false}, {"label": "B", "text": "Osteoid osteoma", "correct": false}, {"label": "C", "text": "Garre’s osteomyelitis", "correct": true}, {"label": "D", "text": "Chronic osteomyelitis", "correct": false}], "correct_answer": "C. Garre’s osteomyelitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/caoZ31PDTaWyaj8aoikY1737952051.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fQ6VnSThk3ogP1KixosQ1743764809.mp3", "video": ""}, {"text": "A 10 y/o child presents with localised pain and swelling in the lower leg. Radiographic examination reveals a circumscribed, round area of lucency in the metaphysis of the tibia, surrounded by a halo of sclerosis. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Brodie's abscess", "correct": true}, {"label": "B", "text": "Garre’s osteomyelitis", "correct": false}, {"label": "C", "text": "Salmonella osteomyelitis", "correct": false}, {"label": "D", "text": "Ewing’s sarcoma", "correct": false}], "correct_answer": "A. Brodie's abscess", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/i7bMqxikbyrEUs7Eh6oe1737951982.png", "https://image.prepladder.com/content/yvDiePOzlik20Xxw2HW81737951927.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/BMZxGw2buyArvfHu84Of1743764292.mp3", "video": ""}, {"text": "A 10-year-old boy presents with acute fever pain and tenderness in his right leg. Which of the following is the most appropriate initial step in management?", "options": [{"label": "A", "text": "Wait for culture and sensitivity results before starting antibiotics", "correct": false}, {"label": "B", "text": "Administer oral antibiotics for 2 weeks", "correct": false}, {"label": "C", "text": "Start empirical IV antibiotics immediately", "correct": true}, {"label": "D", "text": "Proceed directly with surgical drainage", "correct": false}], "correct_answer": "C. Start empirical IV antibiotics immediately", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Reference:</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Antimicrobial Therapy </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Immediate <span class=\"customMeta\" data-dictid=\"95c41bced21692777187fa909c1937\">empirical</span> IV antibiotics. <strong>(Option C)</strong></li>\n<li>Antibiotics are switched to targeted drugs after culture results. <strong>(Option A ruled out)</strong></li>\n<li>Antibiotic course involves IV for 2–4 weeks, followed by oral for 3–6 weeks. <strong>(Option B ruled out)</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Surgical <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">Drainage</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Indicated if no improvement is observed within 36 hours, signs of deep pus, or aspirated pus. <strong>(Option D ruled out)</strong></li>\n<li>Abscess is drained via open surgery, drilling, or creating a <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> window.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Splintage &amp; Rest</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recommended for comfort and to prevent joint contractures.</li>\n<li>Methods include skin traction, <span class=\"customMeta\" data-dictid=\"6c22f2390016927771955c0c04b851\">plaster</span> slab, or half-cylinder depending on the site.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Supportive Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Regular administration of analgesics for pain. IV fluids are used to address dehydration.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/dTIGlWxvCDgNClVl4rxq1743763595.mp3", "video": ""}, {"text": "A 7 y/o child presents with fever, acute tenderness, and swelling in the left leg. The child is experiencing severe pain even with a gentle touch and shows reluctance to move the limb. What is the confirmatory investigation to diagnose the child’s condition?", "options": [{"label": "A", "text": "MRI", "correct": false}, {"label": "B", "text": "CT imaging", "correct": false}, {"label": "C", "text": "Aspiration of pus", "correct": true}, {"label": "D", "text": "Bone scan", "correct": false}], "correct_answer": "C. Aspiration of pus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/tITcnpAyOLzvPv8f0Nog1737951821.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/QuORJlKvz7RhG75pkCK21745755768.mp3", "video": ""}, {"text": "A 5 y/o child presents with acute tenderness in the groin, refusing to move the affected leg, and appears to have a \"paralyzed\" limb. Upon examination, even gentle manipulation causes significant pain. Which of the following conditions could be a potential cause of this condition?", "options": [{"label": "A", "text": "Acute osteomyelitis", "correct": false}, {"label": "B", "text": "Scurvy", "correct": false}, {"label": "C", "text": "Congenital syphilis", "correct": false}, {"label": "D", "text": "All of the above", "correct": true}], "correct_answer": "D. All of the above", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/A5z0XtIcaAoVjpwMQjL21741609470.mp3", "video": ""}, {"text": "Which of the following statements about Hobo's and Trueta's theories of acute osteomyelitis is true?", "options": [{"label": "A", "text": "Hobo suggested that acute osteomyelitis develops due to sluggish blood flow in capillary loops.", "correct": true}, {"label": "B", "text": "Hobo indicated that infection in the metaphysis occurs primarily due to direct invasion of the periosteum.", "correct": false}, {"label": "C", "text": "Trueta's theory states that infection begins in “blood lakes” at the intrametaphyseal capillary loop where blood flow is faster.", "correct": false}, {"label": "D", "text": "Growth cartilage completely protects the epiphysis from infection spread in infants.", "correct": false}], "correct_answer": "A. Hobo suggested that acute osteomyelitis develops due to sluggish blood flow in capillary loops.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/9W6k00vOvDkseUwOC58z1737951646.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/gOo0KP7DPTuJ8Hw3JgfC1741609052.mp3", "video": ""}, {"text": "A 10-year-old girl is brought to the hospital with a 7-day history of severe pain in her proximal tibia, accompanied by fever and swelling. Imaging studies show signs of bone infection. Which of the following findings would most likely be observed by the end of Week 1 of infection? Formation of granulation tissue around the infection. Development of a subperiosteal abscess. Presence of sequestra. Involucrum formation.", "options": [{"label": "A", "text": "1 and 2", "correct": false}, {"label": "B", "text": "3 only", "correct": true}, {"label": "C", "text": "2 only", "correct": false}, {"label": "D", "text": "1, 3, and 4", "correct": false}], "correct_answer": "B. 3 only", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/mGjpwhE4bHhhNaIfBTUZ1737951573.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/qB0K45Aynv0Hj6ouUz5g1741608596.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 37 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 8</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Bone Infections-Previous Year Questions - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 8</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. 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The limb is warm to the touch, and ESR is raised. An X-ray reveals periosteal elevation. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Ewing sarcoma", "correct": false}, {"label": "B", "text": "Osteosarcoma", "correct": false}, {"label": "C", "text": "Osteomyelitis", "correct": true}, {"label": "D", "text": "Giant Cell Tumor (GCT)", "correct": false}], "correct_answer": "C. Osteomyelitis", "question_images": ["https://image.prepladder.com/content/phuM81OlpPGkmisL3pEH1748205848.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old male presents to the OPD with complaints of pain in the left knee region. He reports that the pain is often worse at night and mentions that he has been taking Aspirin to relieve the pain. An X-ray of the knee is shown below. What is the diagnosis?", "options": [{"label": "A", "text": "Chondroblastoma", "correct": false}, {"label": "B", "text": "Osteoid osteoma", "correct": true}, {"label": "C", "text": "Skeletal TB", "correct": false}, {"label": "D", "text": "Osteosarcoma", "correct": false}], "correct_answer": "B. Osteoid osteoma", "question_images": ["https://image.prepladder.com/content/18ObwzOS0F8hOnXLnLLF1747376535.png"], "explanation_images": ["https://image.prepladder.com/content/O8wifnI1MczLaJ4JZDOu1747376547.png", "https://image.prepladder.com/content/qQVN2ZSQUTqq3QeeQeii1747376562.png", "https://image.prepladder.com/content/Gp3bRbuPIaLHwlc8DhpC1747376594.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Osteoid Osteoma</strong></p>\n<p>A small, <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> bone tumor composed of <span class=\"customMeta\" data-dictid=\"74fb39c2cd1692777194eae8b91386\">osteoid</span> and woven bone with a surrounding <span class=\"customMeta\" data-dictid=\"95af91681416927771887742113c38\">halo</span> of <span class=\"customMeta\" data-dictid=\"092583d1b41692777197a506409267\">reactive</span> bone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Demographics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sex: </strong>Males &gt; Females</p>\n<p><strong>Age: </strong>Young patients, but rare under 5 years and over 30.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>The <span class=\"customMeta\" data-dictid=\"604558eae21692777186613f3915a9\">diaphysis</span> </strong>of long bones, especially <strong>the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> tibia, and femur.</strong></p>\n<p>It can also occur in the <strong>spine</strong>, particularly the <strong>posterior arches.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"00375928541692777193ce8621da42\">nidus</span> <strong>releases prostaglandins</strong> which cause the characteristic pain that relieves on taking NSAIDs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Characterized by <strong>pain, often worse at night (Night crises), and relieved by NSAIDs (<em>Therapeutic test</em>).</strong></p>\n<p>When near joints, it may cause <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> and effusion.</p>\n<p>In the spine, it can lead to muscle spasms and scoliosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>X-Ray: </strong></p>\n<p>Dense <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> with a small, <strong>rounded area of osteolysis</strong>, often obscured by the surrounding sclerosis.</p>\n<p>The characteristic <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> is<strong> less than 1.5 cm in diameter</strong> with a <strong>sclerotic margin and <span class=\"customMeta\" data-dictid=\"17825c11c616927771979bd9b0b285\">radiolucent</span> nidus. </strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/O8wifnI1MczLaJ4JZDOu1747376547.png\" width=\"500\"/></p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Adlan, Amirul &amp; Azzopardi, Christine &amp; Davies, Mark &amp; James, Steven &amp; Botchu, R\" data-hash=\"\" data-license=\"CC BY-NC-ND 4.0\" data-source=\"https://www.researchgate.net/figure/Right-leg-anteroposterior-radiograph-showing-osteoid-osteoma-arrow-with-marked-cortical_fig1_361999794\" data-tags=\"\" height=\"1349\" src=\"https://image.prepladder.com/content/qQVN2ZSQUTqq3QeeQeii1747376562.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Isotope bone scans (Best investigation) </strong>are positive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Consists of a <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> of woven bone, osteoblastic rimming, osteoclasts, and dilated capillaries.</p>\n<p>The <strong>mature <span class=\"customMeta\" data-dictid=\"74fb39c2cd1692777194eae8b91386\">osteoid</span> forms the nidus, </strong>surrounded by <strong>dense, <span class=\"customMeta\" data-dictid=\"092583d1b41692777197a506409267\">reactive</span> bone and soft tissue with <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> changes.</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Osteoid_osteoma_-_very_high_mag.jpg\" data-tags=\"\" height=\"335\" src=\"https://image.prepladder.com/content/Gp3bRbuPIaLHwlc8DhpC1747376594.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CT-guided <span class=\"customMeta\" data-dictid=\"07f73f8986169277719716f3a62e1b\">radiofrequency</span> ablation.</strong></p>\n<p>Surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> of the nidus<strong> (gold standard)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequent pattern of involvement observed in Pott’s spine?", "options": [{"label": "A", "text": "Paradiscal", "correct": true}, {"label": "B", "text": "Central", "correct": false}, {"label": "C", "text": "Anterior", "correct": false}, {"label": "D", "text": "Posterior", "correct": false}], "correct_answer": "A. Paradiscal", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Ring sequestrum is seen in?", "options": [{"label": "A", "text": "Fungal infection", "correct": false}, {"label": "B", "text": "Septic arthritis", "correct": false}, {"label": "C", "text": "Pin tract infections", "correct": true}, {"label": "D", "text": "Acute osteomyelitis", "correct": false}], "correct_answer": "C. Pin tract infections", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/QHndqx9dGSeLGjG8aMCj1746523458.png", "https://image.prepladder.com/notes/YJsy7Jpu1NXB7Upx5afS1746523483.png", "https://image.prepladder.com/notes/iRzvlNZ9NYMX37ZbpfZX1746523509.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Types of Sequestrum</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tubular</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pyogenic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ring</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>External <span class=\"customMeta\" data-dictid=\"92985ebc231692777202e3345af0aa\">Fixator</span> (Pin <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Black</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Actinomycosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Coralliform</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Perthe’s Disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Coke</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tuberculosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sandy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tuberculosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Feathery/ Ivory</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Syphilis</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"text-align:center\">\n<figure class=\"caption_element\"><img alt=\"Coke Sequestrum\" data-author=\"Vivek Trikha, Manish Varshney, Shishir Rastog\" data-hash=\"12197\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Case-1-CT-scan-of-the-pelvis-showing-the-coke-sequestrum-inside-the-lytic-cavity-in-the_fig2_7709045\" data-tags=\"May2025\" height=\"302\" src=\"https://image.prepladder.com/notes/QHndqx9dGSeLGjG8aMCj1746523458.png\" width=\"387\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"text-align:center\">\n<figure class=\"caption_element\"><img alt=\"Ring Sequestrum\" data-author='\"Dr. Sivakumar Raju, Dr. Prahalad Kumar Singhi, Dr. Somashekar V and Dr. Raghava Kumar VP\"' data-hash=\"12201\" data-license=\"CC BY-NC\" data-source=\"https://www.orthocasereports.com/archives/2020.v2.i2.A.22\" data-tags=\"May2025\" height=\"300\" src=\"https://image.prepladder.com/notes/YJsy7Jpu1NXB7Upx5afS1746523483.png\" width=\"221\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"text-align:center\"><strong>Coke sequestrum</strong></td>\n<td style=\"text-align:center\"><strong>Ring sequestrum</strong></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 12-year-old boy presents with a gradually progressing swelling and dull aching pain since 6 months in his lower leg .He is otherwise healthy. The radiographic image of his leg is shown below. The most likely diagnosis is:", "options": [{"label": "A", "text": "Osteosarcoma", "correct": false}, {"label": "B", "text": "Osteoblastoma", "correct": false}, {"label": "C", "text": "Brodie's abscess", "correct": true}, {"label": "D", "text": "Ewing's sarcoma", "correct": false}], "correct_answer": "C. Brodie's abscess", "question_images": ["https://image.prepladder.com/content/NL3ETqFyDXFRxmsE1nzr1691507447.png"], "explanation_images": [], "explanation": "<p>Correct Option C - Brodie's A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a history of a road traffic accident 2 years back, and has developed pain and swelling now at the same site . His X-ray image is shown in the image given below. What is the probable diagnosis?", "options": [{"label": "A", "text": "Osteogenic sarcoma", "correct": false}, {"label": "B", "text": "Ewing's sarcoma", "correct": false}, {"label": "C", "text": "Chronic osteomyelitis", "correct": true}, {"label": "D", "text": "Multiple myeloma", "correct": false}], "correct_answer": "C. Chronic osteomyelitis", "question_images": ["https://image.prepladder.com/content/KQNWyhIhJPw6RcNlRwN71700216744.png"], "explanation_images": [], "explanation": "<p>Correct Option C - Chronic O\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "De Quervain's tenosynovitis involves the tendons of which muscles ?", "options": [{"label": "A", "text": "Extensor pollicis longus and abductor pollicis longus", "correct": false}, {"label": "B", "text": "Extensor pollicis longus and abductor pollicis brevis", "correct": false}, {"label": "C", "text": "Extensor pollicis brevis and abductor pollicis brevis", "correct": false}, {"label": "D", "text": "Extensor pollicis brevis and abductor pollicis longus", "correct": true}], "correct_answer": "D. Extensor pollicis brevis and abductor pollicis longus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/gxgwPZ6skvVQ8FsWhvZK1700157136.png"], "explanation": "<p>Correct Option D - Extensor pollicis brevis and &lt;span class=\"customMeta\" data-dictid=\"1a19c0413216927771801f371db10e\"&gt;abductor&lt;/span&gt; pollicis longu\n<table>\n<tbody>\n<tr>\n<td colspan=\"2\">\n<p style=\"text-align:center\"><strong>De Quervain's Disease (De Quervain's Tenosynovitis)</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Pathophysiology</strong></p>\n</td>\n<td>\n<p>Inflammation and <span class=\"customMeta\" data-dictid=\"3a74ed0fcf16927771901a79847565\">irritation</span> of the tendons and their surrounding sheath</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Common Causes</strong></p>\n</td>\n<td>\n<p>Repetitive hand and wrist motions, overuse injuries</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Symptoms</strong></p>\n</td>\n<td>\n<ul>\n<li>Pain and <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> at the base of the thumb</li>\n<li>Pain worsens with thumb and wrist movement</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Diagnosis</strong></p>\n</td>\n<td>\n<p>Clinical evaluation, physical examination, Finkelstein's test</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Treatment</strong></p>\n</td>\n<td>\n<ul>\n<li>Splinting or immobilizing the thumb and wrist</li>\n<li>Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief</li>\n<li>In severe cases, <span class=\"customMeta\" data-dictid=\"a3e96d80e9169277718551158bbcd4\">corticosteroid</span> injections or <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the characteristic sign of a simple bone cyst?", "options": [{"label": "A", "text": "Fallen fragment sign", "correct": true}, {"label": "B", "text": "Scalloping of cortex", "correct": false}, {"label": "C", "text": "Never breaches physis", "correct": false}, {"label": "D", "text": "Central radiolucent lesion", "correct": false}], "correct_answer": "A. Fallen fragment sign", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/BuMGoBzhpxcXj5C14uEN1718084976.png"], "explanation": "<p>Correct Option A - Fallen Fragment Sig\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 18 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 25</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Bone Tumors-Bone Tumours - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 25</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 25 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 12-year-old boy presents with a history of mild pain in his right shoulder following a minor fall. The X-ray is shown below. There is no significant swelling or erythema. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Osteosarcoma", "correct": false}, {"label": "B", "text": "Aneurysmal Bone Cyst", "correct": false}, {"label": "C", "text": "Fibrous Dysplasia", "correct": false}, {"label": "D", "text": "Simple Bone Cyst", "correct": true}], "correct_answer": "D. Simple Bone Cyst", "question_images": ["https://image.prepladder.com/content/yjbbs42DOs42kd9g5Frb1738357145.png"], "explanation_images": ["https://image.prepladder.com/content/AZNLEswhED7LLz462eyo1738357012.png", "https://image.prepladder.com/content/Yfex63vUPOehdC8GWJDo1738357036.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Simple Bone <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">Cyst</span> (SBC) / <span class=\"customMeta\" data-dictid=\"a8de24b7a01692777201b04d999cae\">Unicameral</span> bone cyst</strong></p>\n<p>A solitary, usually <strong>unilocular, <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> bone cavity</strong> filled with <span class=\"customMeta\" data-dictid=\"3963a2e0fa169277719874304f5705\">serous</span> or serosanguinous fluid and lined by a <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> membrane.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age:</strong> Presents in the first two decades of life.</p>\n<p><strong>Sex: </strong>More common in males. (2:1)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Commonly affects the<strong> <span class=\"customMeta\" data-dictid=\"8ccb80bd4d169277719296d80e2193\">metaphysis</span> close to the physis.</strong></p>\n<p>Most frequently occurs in the<strong> <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> humerus, <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> femur, and <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> tibia.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often <strong>asymptomatic</strong>, discovered <strong>incidentally.</strong></p>\n<p><strong>Pathological fracture</strong> is a common presentation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Active cyst</strong>: If the <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> is situated<strong> close to the <span class=\"customMeta\" data-dictid=\"dc486020a916927771874098596bbc\">epiphyseal</span> plate.</strong></p>\n<p><strong>Latent cyst</strong>: If the <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> <strong>moves away from the growth plate. </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiological Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray:</strong></p>\n<p>Well-outlined, <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> located centrally in the metaphysis.</p>\n<p>Expands and thins the cortex.</p>\n<p><strong>Fallen leaf sign: </strong>a small bone fragment within the <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> following a fracture</p>\n<img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/AZNLEswhED7LLz462eyo1738357012.png\" width=\"1882\"/>\n<p><strong>Trap-door sign:</strong> a small bone fragment hinges at the cortex.</p>\n\t\t\t <img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/Yfex63vUPOehdC8GWJDo1738357036.png\" width=\"1868\"/>\n<p><strong>MRI: </strong>Homogeneous, fluid-filled cavity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Connective tissue lining with <span class=\"customMeta\" data-dictid=\"e2071f8f891692777203982b3fa0f5\">foci</span> of <span class=\"customMeta\" data-dictid=\"092583d1b41692777197a506409267\">reactive</span> bone.</p>\n<p>It has characteristic giant cells.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Percutaneous <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> injections for active lesions.</p>\n<p>Curettage and bone grafting.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/TUaEYx3KENJMSAnJQ0UE1743954246.mp3", "video": ""}, {"text": "Which of the following is the cause of the indicated arrow?", "options": [{"label": "A", "text": "Scurvy", "correct": false}, {"label": "B", "text": "Osteosarcoma", "correct": false}, {"label": "C", "text": "Syphilis", "correct": false}, {"label": "D", "text": "All of the above", "correct": true}], "correct_answer": "D. All of the above", "question_images": ["https://image.prepladder.com/content/QbbO031wgj9FknhFS0W21738359611.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Vascular</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Haemophilia and other <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> disorders</li>\n<li>Myeloid <span class=\"customMeta\" data-dictid=\"cb4dfcbab11692777192d282b3be7a\">metaplasia</span> (thrombocytopenia)</li>\n<li>Erythroblastic anemias</li>\n<li>Leukaemias</li>\n<li>Varicose veins</li>\n<li>Hypertrophic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> osteoarthropathy</li>\n<li>Pachydermoperiostosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Physiologic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Prematurity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Dysplastic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Melorheostosis</li>\n<li>Engelmann's disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Traumatic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Local <span class=\"customMeta\" data-dictid=\"98c8f7f96f1692777199295afb1d35\">subperiosteal</span> trauma</li>\n<li>Fractures (including march fractures)</li>\n<li>Unrecognized skeletal trauma (Caffey's syndrome)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Hypo/Hypervitaminosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Rickets</li>\n<li><strong>Scurvy</strong></li>\n<li>Hypervitaminosis A</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Infective</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Acute osteomyelitis</strong> (staphylococcal, streptococcal, pneumococcal)</li>\n<li>Brodie's abscess</li>\n<li>Tuberculosis</li>\n<li><strong>Syphilis</strong><strong> </strong>(congenital and acquired)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Neoplastic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Primary:\n\t\t\t\t<ul>\n<li>Benign :meningioma, angioma, <span class=\"customMeta\" data-dictid=\"74fb39c2cd1692777194eae8b91386\">osteoid</span> osteoma</li>\n<li>Malignant: <strong>osteogenic <span class=\"customMeta\" data-dictid=\"82068425041692777198fe3064c370\">sarcoma</span> </strong><strong>(only this is called Codman's triangle)</strong>, fibrosarcoma, Ewing's sarcoma</li>\n</ul>\n</li>\n<li>Secondary: metastatic bony deposits</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Endocrine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Thyroid acropachy</li>\n<li>Hyperparathyroidism</li>\n<li>Secondary <span class=\"customMeta\" data-dictid=\"a21c150dc716927771893624a49628\">hyperparathyroidism</span> in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> osteodystrophy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Primary Joint Lesions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Ankylosing spondylitis</li>\n<li>Juvenile chronic <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> (Still's disease)</li>\n<li>Reiter's syndrome</li>\n<li>Rheumatoid arthritis</li>\n<li>Osteoarthritis (femoral neck only)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Congenital</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Tuberous sclerosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Miscellaneous</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Infantile <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> hyperostosis</li>\n<li>Histiocytosis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/cW5x7KhK9noZCRGymobo1743957575.mp3", "video": ""}, {"text": "A 70-year-old man comes to the clinic for a routine check-up. During the visit, he shared his family history of bone tumors, mentioning that several relatives have passed away from various types of bone cancers. Concerned about his own risk, he asks the doctor which type of bone malignancy he should be most vigilant about.", "options": [{"label": "A", "text": "Osteochondroma", "correct": false}, {"label": "B", "text": "Osteoclastoma", "correct": false}, {"label": "C", "text": "Ewing's Sarcoma", "correct": false}, {"label": "D", "text": "Multiple Myeloma", "correct": true}], "correct_answer": "D. Multiple Myeloma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/QeoVdeQ5Pkugsa8SjW5B1743957496.mp3", "video": ""}, {"text": "A 15-year-old girl comes to the clinic with persistent pain and swelling in her right knee that has been worsening over the past few months. During her family history discussion, her mother recalls that a distant relative had primary bone cancer in their youth. Concerned about the possibility of a serious condition, the girl asks the doctor which type of bone malignancy is most commonly seen in adolescents like her.", "options": [{"label": "A", "text": "Osteogenic Sarcoma", "correct": true}, {"label": "B", "text": "Synovial Sarcoma", "correct": false}, {"label": "C", "text": "Reticulum cell sarcoma", "correct": false}, {"label": "D", "text": "Ewing’s sarcoma", "correct": false}], "correct_answer": "A. Osteogenic Sarcoma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Osteogenic <span class=\"customMeta\" data-dictid=\"82068425041692777198fe3064c370\">Sarcoma</span> (Osteosarcoma)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Most common primary <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> bone tumor</strong> of non-hematopoietic origin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Tissue Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Solid <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> bone tumor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Bimodal distribution: peaks in<strong> adolescence</strong> (10–14 years) and again in the seventh decade</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Gender Prevalence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>More common in males than females</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Common Sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>1. Lower end of femur</p>\n<p>2. Upper end of tibia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Location of Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Arises from the <span class=\"customMeta\" data-dictid=\"8ccb80bd4d169277719296d80e2193\">metaphysis</span> of long bones</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/MyX6ifIMfIZ5OKKVa1PB1743957393.mp3", "video": ""}, {"text": "All of the following are correctly matched bone tumors except? 1. Most common bone tumors Secondaries 2. Most common primary benign bone tumor Osteoblastoma 3. Most common primary malignant bone tumor Osteogenic sarcoma. 4. Most Common bone tumor in elderly Multiple myeloma.", "options": [{"label": "A", "text": "1", "correct": false}, {"label": "B", "text": "2", "correct": true}, {"label": "C", "text": "3", "correct": false}, {"label": "D", "text": "4", "correct": false}], "correct_answer": "B. 2", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:523px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>1. Most common bone tumors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Secondaries from:</p>\n<ul>\n<li>Prostrate</li>\n<li>Breast</li>\n<li>Kidney</li>\n<li>Thyroid</li>\n<li>Lung</li>\n</ul>\n<p><strong>Pb KTL (Lead Kettle)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2. Most common primary <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> bone tumor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Osteochondroma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3. Most common primary <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> bone tumor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Osteogenic sarcoma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4. Most Common bone tumor in elderly</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multiple myeloma.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Also Called</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Exostosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Type</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Most <strong>common primary <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> bone tumor</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Structure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>An offshoot from <span class=\"customMeta\" data-dictid=\"b2a22f1dff169277719977c0a8ee4a\">spongy</span> bone tissue with a <span class=\"customMeta\" data-dictid=\"a2a990a23c1692777183c6b47c7819\">cartilaginous</span> cap</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Cause</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Due to unwanted activity of the <span class=\"customMeta\" data-dictid=\"dc12e433981692777183c04d16248d\">cambium</span> layer of the periosteum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Most Common Age</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Growth period (teenagers, during growth spurts)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Gender Preponderance</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Male</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Most Common Site</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Lower end of the femur</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>2nd Common Site</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Upper end of the tibia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Location</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Around the knee joint; commonly around the <span class=\"customMeta\" data-dictid=\"8ccb80bd4d169277719296d80e2193\">metaphysis</span> of long bones and <span class=\"customMeta\" data-dictid=\"48528974ed1692777185cd29753db5\">crest</span> of ilium</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/mgcI3MwkgLyAJiVvzrMl1743957275.mp3", "video": ""}, {"text": "A 70-year-old female presents with a two-week history of left thumb pain and swelling. She has a history of diabetes, hypertension, and triple-negative carcinoma of mammary origin, diagnosed five years prior. Physical examination reveals swelling and mild ulceration at the distal first phalanx. The X-ray is shown below. What is the most common underlying cause of the patient's thumb lesion?", "options": [{"label": "A", "text": "Primary osteosarcoma", "correct": false}, {"label": "B", "text": "Secondary carcinoma from another site", "correct": true}, {"label": "C", "text": "Secondary osteosarcoma", "correct": false}, {"label": "D", "text": "Osteoclastoma", "correct": false}], "correct_answer": "B. Secondary carcinoma from another site", "question_images": ["https://image.prepladder.com/content/8nUCuiqHV9JSvtDclR6E1738359010.png"], "explanation_images": ["https://image.prepladder.com/content/sNiaOIvC9WSdh0Wssczc1738359273.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:620px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Common Metastatic Tumors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Lung <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> (male)</li>\n<li>Breast <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> (female)</li>\n<li>Prostate <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> <strong>(Osteoblastic)</strong></li>\n<li>Thyroid carcinoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Clinical Features</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Known Primary Malignancy:\n\t\t\t\t<ul>\n<li>Bone pain (common in spine, ribs, extremities)</li>\n<li>Pathological <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> <strong>(common in spine)</strong></li>\n</ul>\n</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li>Unknown Primary Malignancy:\n\t\t\t\t<ul>\n<li>Bone pain leading to destructive <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> diagnosis</li>\n<li>Pathological <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> due to weakened bone</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Malignancies Presenting with Silent Primary</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Thyroid carcinoma</li>\n<li>Renal cell carcinoma</li>\n<li>Bladder carcinoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Common Sites of Metastasis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Vertebral bodies</li>\n<li>Ribs</li>\n<li>Pelvis</li>\n<li>Humerus</li>\n<li>Femur</li>\n<li>Uncommon <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> to elbow and knee</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/CSTDlZQ9lmZUJfmA0Tre1743957184.mp3", "video": ""}, {"text": "A 20-year-old woman presents with a one-year history of progressively worsening thigh pain, initially accompanied by intermittent fevers and malaise. Recently, her pain has intensified to the point of bedridden status. She develops acute confusion and altered consciousness, with laboratory tests revealing severe hypercalcemia and elevated alkaline phosphatase. An X-ray is shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Osteosarcoma", "correct": false}, {"label": "B", "text": "Ewing's sarcoma", "correct": true}, {"label": "C", "text": "Multiple myeloma", "correct": false}, {"label": "D", "text": "Osteoclastoma", "correct": false}], "correct_answer": "B. Ewing's sarcoma", "question_images": ["https://image.prepladder.com/content/eGeKDNOSjxLYsQ0qYVKQ1738358840.png"], "explanation_images": ["https://image.prepladder.com/content/D388DFZMsBMHQ4gMv1sW1738358857.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Ewing's Sarcoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Multiple <span class=\"customMeta\" data-dictid=\"aa6a0dfcb61692777193561ed10fac\">Myeloma</span> (Plasmacytoma)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Age Group Affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>4–25 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>40–60 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Sex Distribution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>More common in males</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Equally affects males and females</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Primary Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Long bones (femur, tibia, fibula, humerus)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Bone (typically spine, skull, pelvis, ribs)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Diaphysis of long bones</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Various bones, often vertebrae</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Intermittent pain, worse at night, fever</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Severe back pain, weakness, weight loss</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Physical Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Fixed tumor, red skin, dilated veins</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Local tenderness, possible <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">pathological</span> fractures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Radiographic Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Lytic, sclerotic, or mixed lesions; <span class=\"customMeta\" data-dictid=\"58c03304521692777195a054ce95e4\">periosteal</span> onion peel appearance; <strong>moth-eaten destruction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Diffuse osteoporosis, <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> lesions;<strong> <span class=\"customMeta\" data-dictid=\"896c5b0b3616927771836c801b78c2\">biconcave</span> vertebrae; <span class=\"customMeta\" data-dictid=\"7134f7f8681692777196fa644c43bf\">punched-out</span> lesions</strong> in skull and pelvis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Histological Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Sheets of small, uniform cells resembling lymphocytes; <strong>pseudo-rosettes </strong>may be present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Round cells with eccentrically placed nuclei; sparse <span class=\"customMeta\" data-dictid=\"77399c6ee0169277718492fb8fd58f\">chromatin</span> arranged in a<strong> “spokes of wheel” pattern;</strong> <span class=\"customMeta\" data-dictid=\"2da8fc47cf169277719576cea1851f\">perinuclear</span> <span class=\"customMeta\" data-dictid=\"95af91681416927771887742113c38\">halo</span> typically not seen</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Poor 5-year survival rate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Variable, but generally better than Ewing's</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Common Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Metastasis to lungs and other organs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Pathological fractures, neurological symptoms</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/F1Kp1g1TNF6ieM078AIH1743957046.mp3", "video": ""}, {"text": "A 58-year-old male presents with a 6-month history of worsening back pain, fatigue, and significant weight loss. He also reports frequent headaches, difficulty concentrating, and numbness in his legs. Physical examination reveals tenderness over the lumbar spine and decreased sensation in the lower extremities. Laboratory investigations show normocytic anemia, hypercalcemia, and elevated serum creatinine. Urinalysis reveals the presence of Bence Jones proteins. A skeletal survey is done. Which of the following is NOT a typical radiological feature of the patient’s most likely condition?", "options": [{"label": "A", "text": "Multiple punched-out lesions in bones", "correct": false}, {"label": "B", "text": "Pepper-pot appearance of the skull", "correct": false}, {"label": "C", "text": "Pathological wedge collapse of vertebrae", "correct": false}, {"label": "D", "text": "Sunburst appearance in long bones", "correct": true}], "correct_answer": "D. Sunburst appearance in long bones", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/OjJ8Nafc4PRLogxBlCrP1738358669.png", "https://image.prepladder.com/content/rif07x5rL0Ghckdi5cHX1738358578.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/CYYKoFfEib8FTaRD3K8v1743956476.mp3", "video": ""}, {"text": "A 25-year-old male has pain and progressive swelling around the proximal part of the left hand for the last 3 months. The X-ray is shown below. A biopsy reveals small, round cells forming pseudo-rosettes. Which of the following is not correct regarding the diagnosis of this patient?", "options": [{"label": "A", "text": "It is a highly malignant tumor of bone, commonly involving diaphysis.", "correct": false}, {"label": "B", "text": "Bone-to-bone metastasis is not common.", "correct": true}, {"label": "C", "text": "The tumor is highly radio-sensitive but prone to recurrence.", "correct": false}, {"label": "D", "text": "Males are more likely to be affected than females.", "correct": false}], "correct_answer": "B. Bone-to-bone metastasis is not common.", "question_images": ["https://image.prepladder.com/content/8SFOK1rfpyCX6GEuIGm01738358337.png"], "explanation_images": ["https://image.prepladder.com/content/To9k371YsemCbPn24Vn91738358401.png"], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Reference:</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/jskjWcjuDU3nGzDX6Bzj1743956315.mp3", "video": ""}, {"text": "A 27-year-old female is diagnosed with a giant cell tumor in her distal femur after presenting with vague pain and swelling. She undergoes surgical excision of the tumor. Which of the following pre-operative X-ray findings is most consistent with giant cell tumors?", "options": [{"label": "A", "text": "Sun-rays appearance", "correct": false}, {"label": "B", "text": "Onion peel appearance", "correct": false}, {"label": "C", "text": "Soap bubble appearance", "correct": true}, {"label": "D", "text": "Pepper pot appearance", "correct": false}], "correct_answer": "C. Soap bubble appearance", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wR0I5YC1zvBi2oahsLYk1738357984.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/rrD5bVT3WdVZkNdWyLy31743956155.mp3", "video": ""}, {"text": "A 32-year-old woman presents with progressive and persistent vague pain and swelling around her right knee for the past 3 months. On physical examination, there is swelling around the distal femur with tenderness. Histopathology shows multinucleated giant cells and spindle-shaped mononuclear stromal cells. Which of the following statements is true regarding the nature of the tumor in this patient?", "options": [{"label": "A", "text": "It commonly arises from the diaphysis of long bones", "correct": false}, {"label": "B", "text": "It is benign but can behave aggressively locally", "correct": true}, {"label": "C", "text": "It most frequently metastasizes to regional lymph nodes", "correct": false}, {"label": "D", "text": "It most commonly affects individuals under the age of 20", "correct": false}], "correct_answer": "B. It is benign but can behave aggressively locally", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/mp1M6uNSfP84tBIkA39s1738358131.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/paJHoIFiUJnfoMCxr9KK1743956027.mp3", "video": ""}, {"text": "A 17-year-old boy presents to orthopedics OPD with mild fever and intermittent thigh pain for the past several months, particularly at night. There is no history of fever and weight loss. On physical exam, there is swelling and tenderness over the distal femur. An X-ray image is shown below. Which of the following best explains the radiological finding in osteosarcoma that is marked with an arrow in the above image?", "options": [{"label": "A", "text": "It represents aggressive periostitis", "correct": false}, {"label": "B", "text": "It represents tumor calcification within the bone", "correct": false}, {"label": "C", "text": "It is a result of the tumor breaking through the periosteum, lifting it off the bone", "correct": true}, {"label": "D", "text": "It indicates early metastasis to the nearby soft tissue", "correct": false}], "correct_answer": "C. It is a result of the tumor breaking through the periosteum, lifting it off the bone", "question_images": ["https://image.prepladder.com/content/DGHnpU6xwqfD7k1qd7Ny1738357677.png"], "explanation_images": ["https://image.prepladder.com/notes/QWkUfbc5GtRcMQWDol7O1744251725.png", "https://image.prepladder.com/content/NVjIR1TPuV22Xw2goee11738357845.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/2WHu0LKVw2o9pZUU9PgG1743955885.mp3", "video": ""}, {"text": "A 15-year-old boy presents with swelling and pain around her left ankle for the past 6 months. The pain is worse at night and unresponsive to analgesics. On examination, there is a firm, poorly defined, tender mass over the distal femur, with shiny skin and prominent veins over the swelling. The X-ray is shown below. Which of the following is true regarding the most common site of origin for the bone tumor that the patient is having in this case?", "options": [{"label": "A", "text": "Hematopoietic cells in the bone marrow", "correct": false}, {"label": "B", "text": "Diaphysis of long bones", "correct": false}, {"label": "C", "text": "Metaphysis of long bones", "correct": true}, {"label": "D", "text": "Epiphyseal plate", "correct": false}], "correct_answer": "C. Metaphysis of long bones", "question_images": ["https://image.prepladder.com/content/FKBe06IH7mQTmJ7q4HmT1738357408.png"], "explanation_images": ["https://image.prepladder.com/notes/XPhp5ZVaZWSxui3FLmmH1748773503.png", "https://image.prepladder.com/content/WSO2D6SHLhjfPQmOyMYa1738357552.png", "https://image.prepladder.com/content/lo2cN8AJ1fKyna8by6jT1738357357.png", "https://image.prepladder.com/content/c5qVwhYovAEum7imvn4y1738357291.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Svycm8Jx3xEumuOG2I5q1743954688.mp3", "video": ""}, {"text": "Match column A (cell type) with column B (tumor) according to the Lichtenstein Classification of bone tumors. Column A Column B 1. Bone a. Giant cell tumor 2. Cartilage b. Eosinophilic granuloma 3. Bone marrow c. Exostosis 4. Uncertain d. Osteoid osteoma", "options": [{"label": "A", "text": "1-d, 2-c, 3-b, 4-a", "correct": true}, {"label": "B", "text": "1-b, 2-c, 3-a, 4-d", "correct": false}, {"label": "C", "text": "1-c, 2-d, 3-a, 4-b", "correct": false}, {"label": "D", "text": "1-a, 2-d, 3-b, 4-c", "correct": false}], "correct_answer": "A. 1-d, 2-c, 3-b, 4-a", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:495px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cell Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Benign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Malignant</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Bone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Osteoid osteoma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Osteosarcoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cartilage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Chondroma or Enchondroma</p>\n<p>Osteochondroma or exostosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Chondrosarcoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Fibrous Tissue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Fibroma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Fibrosarcoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Bone Marrow</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Eosinophilic <span class=\"customMeta\" data-dictid=\"2334b7498b1692777188fa8b2eee36\">granuloma</span> <strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Ewing's sarcoma</p>\n<p>Multiple myeloma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Vascular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Haemangioma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Angiosarcoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Uncertain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Giant cell tumor<strong> </strong></p>\n<p>(osteoclastoma)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Malignant giant cell tumor</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/W7wvGDTHRhYs3r0ciwx41742117069.mp3", "video": ""}, {"text": "A 22-year-old male presents with pain and swelling over the distal radius. X-ray shows an expansile lytic lesion in the epiphysis extending to the metaphysis. Fine needle aspiration (FNA) reveals a bloody aspirate with hemosiderin-laden macrophages. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Giant cell tumor", "correct": false}, {"label": "B", "text": "Aneurysmal bone cyst", "correct": true}, {"label": "C", "text": "Osteosarcoma", "correct": false}, {"label": "D", "text": "Chondroblastoma", "correct": false}], "correct_answer": "B. Aneurysmal bone cyst", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aneurysmal Bone <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">Cyst</span> (ABC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Giant Cell Tumor (GCT)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primarily affects children and teenagers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most common in young adults (15-35 years)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gender</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Equal distribution between males and females</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More common in females (Female: Male ratio 1.5:1)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metaphyses</strong> of long bones (femur, tibia, humerus), spine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epiphyses</strong> of long bones (lower end of femur, upper end of tibia)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pain and swelling</strong>; <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> lesions may cause neurological issues</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Swelling without pain</strong>; late stages show joint limitation and <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">pathological</span> fracture</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>FNAC: <strong>Hemosiderin +</strong></p>\n<p>Blood-filled <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> spaces separated by <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> septae</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>FNAC: <strong>No hemosiderin</strong></p>\n<p>Abundant giant cells with multiple <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> (&gt;150), <span class=\"customMeta\" data-dictid=\"fc5f7fef0e169277719952d19a4532\">spindle</span> cells indicating malignancy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Osteolytic lesion, multiple septations and fluid-fluid levels on MRI</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thin <span class=\"customMeta\" data-dictid=\"d983a6cd671692777198ec423b3b90\">septa</span> with <strong>soap-bubble appearance</strong> on X-ray, <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> thin and expanded, no <span class=\"customMeta\" data-dictid=\"58c03304521692777195a054ce95e4\">periosteal</span> reaction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Curettage, debridement, and in some cases radiation (cautiously)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with <span class=\"customMeta\" data-dictid=\"5a7218da901692777195eb3e60451a\">PMMA</span> or bone grafting; <span class=\"customMeta\" data-dictid=\"2ab822a2e8169277718587402dd25d\">Denosumab</span> and bisphosphonates as <span class=\"customMeta\" data-dictid=\"e405fcd2f2169277718034536f004a\">adjunct</span> therapy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/baahHHJTB4NTPtu7mU5V1743954123.mp3", "video": ""}, {"text": "A 15-year-old female presents with a gradually enlarging, painful swelling over the distal femur. On examination, the swelling is tender and firm. X-ray shows an expansile, lytic lesion with multiple fluid levels in the metaphysis. The most likely diagnosis is:", "options": [{"label": "A", "text": "Giant cell tumor", "correct": false}, {"label": "B", "text": "Osteosarcoma", "correct": false}, {"label": "C", "text": "Aneurysmal bone cyst", "correct": true}, {"label": "D", "text": "Osteoid osteoma", "correct": false}], "correct_answer": "C. Aneurysmal bone cyst", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/xGWPBXdHrEK7m0AtuxsP1738356741.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aneurysmal Bone <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">Cyst</span> (ABC)</strong></p>\n<p>A benign, expansile bone <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> composed of blood-filled <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> spaces.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primarily affects children and teenagers (<strong>10 to 30 years</strong>).</p>\n<p><strong>Males</strong> &gt; Females</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metaphyses</strong> of <strong>long bones</strong> (femur, tibia, humerus).</p>\n<p>Located <strong>subperiosteally.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pain and Swelling.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiological Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray:</strong> <span class=\"customMeta\" data-dictid=\"17825c11c616927771979bd9b0b285\">Radiolucent</span> area situated at the metaphysis.</p>\n<p>Osteolytic, poorly defined <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> elevating and eroding the cortex.</p>\n<img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1098\" src=\"https://image.prepladder.com/content/xGWPBXdHrEK7m0AtuxsP1738356741.png\" width=\"510\"/>\n<p><strong>MRI: </strong>Multiple <span class=\"customMeta\" data-dictid=\"e572b487a11692777190b9f3b05fd3\">intralesional</span> septations and fluid levels.</p>\n<p><strong>Angiography</strong>: <span class=\"customMeta\" data-dictid=\"47d4b14d841692777195ec9f299139\">Persistence</span> of contrast and a <span class=\"customMeta\" data-dictid=\"862d52f48f16927771833544102577\">blush</span> of flow within the lesion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Composed of <strong>blood-filled <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> spaces separated by <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> septae.</strong></p>\n<p>In chronic cases, the <strong>septae may contain woven bone.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgery: </strong>Curettage and bone grafting</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/7pjAGbylSQIwPGLsvQK41743953982.mp3", "video": ""}, {"text": "A 35-year-old male presents with a history of a slowly growing, painless swelling on the forehead for the past 3 years. On examination, a hard, immobile mass is palpated. A CT scan shows a dense, well-circumscribed, bony lesion in the frontal sinus. The most likely diagnosis is:", "options": [{"label": "A", "text": "Fibrous dysplasia", "correct": false}, {"label": "B", "text": "Osteosarcoma", "correct": false}, {"label": "C", "text": "Ivory osteoma", "correct": true}, {"label": "D", "text": "Dermoid cyst", "correct": false}], "correct_answer": "C. Ivory osteoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/919UHMSwTw9A89S6pnCW1738356559.png"], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Reference:</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/HV5JRxj5qsEMjPkyvi2i1743852054.mp3", "video": ""}, {"text": "A 16-year-old boy presents with persistent pain in his right leg, which is worse at night and relieved by ibuprofen. Physical examination is unremarkable, with no swelling or warmth over the affected area. An X-ray of the right leg is shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Simple bone cyst", "correct": false}, {"label": "B", "text": "Osteoid Osteoma", "correct": true}, {"label": "C", "text": "Brodie’s Abscess", "correct": false}, {"label": "D", "text": "Ewing's Sarcoma", "correct": false}], "correct_answer": "B. Osteoid Osteoma", "question_images": ["https://image.prepladder.com/content/c0oxOGl7RB7zuJvVipPs1738356375.png"], "explanation_images": ["https://image.prepladder.com/content/9UFiC4pk5OtVH7DhkQfn1738356412.png", "https://image.prepladder.com/content/WxC0GsjyYFyeS0uVRqxw1738356501.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Osteoid Osteoma</strong></p>\n<p>A small, <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> bone tumor composed of <span class=\"customMeta\" data-dictid=\"74fb39c2cd1692777194eae8b91386\">osteoid</span> and woven bone with a surrounding <span class=\"customMeta\" data-dictid=\"95af91681416927771887742113c38\">halo</span> of <span class=\"customMeta\" data-dictid=\"092583d1b41692777197a506409267\">reactive</span> bone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Demographics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Sex: </strong>Males &gt; Females</li>\n<li><strong>Age: </strong>Young patients, but rare under 5 years and over 30.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>The <span class=\"customMeta\" data-dictid=\"604558eae21692777186613f3915a9\">diaphysis</span> </strong>of long bones, especially <strong>the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> tibia, and femur.</strong></li>\n<li>It can also occur in the <strong>spine</strong>, particularly the <strong>posterior arches.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"00375928541692777193ce8621da42\">nidus</span> <strong>releases prostaglandins</strong> which cause the characteristic pain that relieves on taking NSAIDs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Characterized by <strong>pain, often worse at night (Night crises), and relieved by NSAIDs (</strong><strong><em>Therapeutic test</em></strong><strong>).</strong></li>\n<li>When near joints, it may cause <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> and effusion.</li>\n<li>In the spine, it can lead to muscle spasms and scoliosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-Ray: </strong></p>\n<ul>\n<li>Dense <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> with a small, <strong>rounded area of osteolysis</strong>, often obscured by the surrounding sclerosis.</li>\n<li>The characteristic <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> is<strong> less than 1.5 cm in diameter</strong> with a <strong>sclerotic margin and <span class=\"customMeta\" data-dictid=\"17825c11c616927771979bd9b0b285\">radiolucent</span> nidus. </strong></li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/9UFiC4pk5OtVH7DhkQfn1738356412.png\" width=\"741\"/></p>\n<p><strong>Isotope bone scans (Best investigation) </strong>are positive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Consists of a <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> of woven bone, osteoblastic rimming, osteoclasts, and dilated capillaries.</li>\n<li>The <strong>mature <span class=\"customMeta\" data-dictid=\"74fb39c2cd1692777194eae8b91386\">osteoid</span> forms the nidus, </strong>surrounded by <strong>dense, <span class=\"customMeta\" data-dictid=\"092583d1b41692777197a506409267\">reactive</span> bone and soft tissue with <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> changes.</strong></li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1098\" src=\"https://image.prepladder.com/content/WxC0GsjyYFyeS0uVRqxw1738356501.png\" width=\"1640\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>CT-guided <span class=\"customMeta\" data-dictid=\"07f73f8986169277719716f3a62e1b\">radiofrequency</span> ablation.</strong></li>\n<li>Surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> of the nidus<strong> (gold standard)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/9TOmQdE4piVKcP5chUM31743851925.mp3", "video": ""}, {"text": "A 19-year-old male presents with mild, intermittent knee pain for 6 months. X-ray shows an eccentric, lytic lesion in the proximal tibial metaphysis without periosteal reaction. Biopsy reveals stellate cells in a myxoid background. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Osteosarcoma", "correct": false}, {"label": "B", "text": "Chondromyxoid Fibroma", "correct": true}, {"label": "C", "text": "Osteoid Osteoma", "correct": false}, {"label": "D", "text": "Giant Cell Tumor", "correct": false}], "correct_answer": "B. Chondromyxoid Fibroma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Ldjdta9LW5wZcq1b42V91738356236.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chondromyxoid Fibroma</strong></p>\n<p>The<strong> least common, <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> cartilaginous</strong> bone tumor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Demographics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sex:</strong> Slightly more common in <strong>males.</strong></p>\n<p><strong>Age: </strong>Teenagers and young adults (<strong>2nd and 3rd decade</strong> of life).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metaphyses</strong> of long bones,</p>\n<p>particularly the <strong>proximal <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> and pelvis.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Slow-growing <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> with pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray:</strong></p>\n<p>Small, metaphyseal, <span class=\"customMeta\" data-dictid=\"897ef2d27c16927771861eb7f4726c\">eccentric</span> <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> lesions, lying <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to the bone's long axis.</p>\n<p>The <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> is<strong> expanded,</strong> thin, and interrupted. <span class=\"customMeta\" data-dictid=\"0a36e18386169277719259641cf29b\">Medullary</span> margins are <strong>scalloped and sclerosed.</strong></p>\n\t\t\t \n\n\t\t\t<p>It erupts through the <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> <strong>with minimal <span class=\"customMeta\" data-dictid=\"58c03304521692777195a054ce95e4\">periosteal</span> or soft tissue reaction</strong>.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/Ldjdta9LW5wZcq1b42V91738356236.png\" width=\"1297\"/></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stellate cells</strong> on a <strong>myxoid background</strong>. <span class=\"customMeta\" data-dictid=\"e0da80f7b91692777192668c299922\">Mitotic figures</span> are rare, though <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> <span class=\"customMeta\" data-dictid=\"79886dc4391692777182791548ca21\">atypia</span> may occur.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Small tumors: </strong>Local <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> and bone grafting</p>\n<p><strong>large tumors: </strong>Wide <span class=\"customMeta\" data-dictid=\"fc695a78ad16927771878f69871998\">en</span> bloc excision</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/0jsakpj43VjmZ6BNeKli1743851827.mp3", "video": ""}, {"text": "A 15-year-old male presents with localized pain and joint stiffness around the knee. Radiographic examination reveals a well-defined lytic lesion in the epiphysis of a long bone. Histological analysis shows a \"wet-sawdust\" appearance and \"chicken-wire\" calcification. Which of the following statements regarding this condition is correct?", "options": [{"label": "A", "text": "It is most commonly diagnosed in patients over 35 years of age.", "correct": false}, {"label": "B", "text": "They are confined within the epiphyses of long bones.", "correct": false}, {"label": "C", "text": "Recurrence occurs in approximately 10% of cases after treatment.", "correct": true}, {"label": "D", "text": "It is more prevalent in females compared to males.", "correct": false}], "correct_answer": "C. Recurrence occurs in approximately 10% of cases after treatment.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/96u6EHdp6xuTFTKC9aF41738356126.png", "https://image.prepladder.com/content/kKVPd8JMOxPhNNeQC6Ve1738356082.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:475px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevalence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 1% of all bone neoplasms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age Distribution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Peak <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> at 10-20 years; rare &lt;10 or &gt;35 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gender</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More prevalent in males than females <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:417px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Well-defined, round or <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> lesions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Size</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically 1 to 7 cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cortical Expansion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May show expansion without breach</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MRI Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Homogeneous high-signal lesions</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:546px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Curettage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor scraping with/without bone grafting</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiofrequency Ablation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> heat treatment</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>En-bloc Resection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aggressive removal with healthy margin for recurrence</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Joint Preservation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Focus on maintaining adjacent joint integrity</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/BqjhRRea2Szi5FU1OdWG1745756375.mp3", "video": ""}, {"text": "A 25-year-old patient presents with a well-defined, radiolucent lesion in the distal phalanx of the hand. Radiographic findings reveal rounded, lobulated edges with characteristic \"popcorn-like\" opacities. The lesion measures 4 cm in diameter and is asymptomatic. Based on these findings, what is the most appropriate management for this condition?", "options": [{"label": "A", "text": "Curettage of the lesion", "correct": false}, {"label": "B", "text": "Serial X-rays for monitoring", "correct": true}, {"label": "C", "text": "Immediate surgical excision", "correct": false}, {"label": "D", "text": "Observation without intervention", "correct": false}], "correct_answer": "B. Serial X-rays for monitoring", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/fKwyfKz8uZbeClpNSfIO1738355866.png", "https://image.prepladder.com/content/YnNfUnnU0mi6OmBxRwMF1738355819.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/sN7xKycG3BRLw5vYh6k51745756223.mp3", "video": ""}, {"text": "An X-ray image shows multiple large chondromas in the hands and feet of a 28-year-old female patient. Based on this radiological finding, which of the following statements is false regarding her condition?", "options": [{"label": "A", "text": "The presence of large chondromas may indicate a higher risk of malignant transformation.", "correct": false}, {"label": "B", "text": "These chondromas can lead to bone expansion and thinning of the cortex.", "correct": false}, {"label": "C", "text": "Surgical excision of all chondromas is the standard treatment to prevent malignant transformation.", "correct": true}, {"label": "D", "text": "Patients with multiple chondromas have an increased risk of extra-skeletal malignancies", "correct": false}], "correct_answer": "C. Surgical excision of all chondromas is the standard treatment to prevent malignant transformation.", "question_images": ["https://image.prepladder.com/content/jGtezZx7t3KVYuG6VHaI1738355486.png"], "explanation_images": ["https://image.prepladder.com/content/a2GxKSpoG0UNANm6zuyp1738355476.png", "https://image.prepladder.com/content/urFjYpLeJzAONNeuuMxq1738355585.png", "https://image.prepladder.com/content/fRHSAXipuunkHTn2cs6m1738355704.png", "https://image.prepladder.com/content/BYJ3xco3NDys1ZpBAKS01738355528.png", "https://image.prepladder.com/content/N08TD92sIe9HYGWpoqQx1738355648.png", "https://image.prepladder.com/content/cdSN0F5CeNaPfGgwiAEZ1738355433.png"], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Reference:</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:607px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually diagnosed in childhood</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most chondromas found in <span class=\"customMeta\" data-dictid=\"b9f9358d0d1692777195323daee87f\">phalangeal</span> bones</p>\n<br/>\n<img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/urFjYpLeJzAONNeuuMxq1738355585.png\" width=\"1896\"/></td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common findings:</strong></p>\n<p>Asymmetric limb shortening</p>\n<p>Swelling of fingers/toes</p>\n<p>Impaired movement of <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joints</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Distribution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can be <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> or bilateral</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Progression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>New chondromas typically stop after puberty</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor growth in adulthood may indicate malignancy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Risk of <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">pathological</span> fractures</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Malignant Transformation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20-30% risk of secondary chondrosarcoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transformation usually occurs in the 30s or 40s</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Warning signs:</strong></p>\n<p>Increase in size of existing chondroma</p>\n<p>New symptoms</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:598px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multiple chondromas with hemangiomas</p>\n<img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1019\" src=\"https://image.prepladder.com/content/fRHSAXipuunkHTn2cs6m1738355704.png\" width=\"845\"/><br/>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptoms can appear at birth or later</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiographic Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>X-rays show large chondromas</p>\n<img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"325\" src=\"https://image.prepladder.com/content/BYJ3xco3NDys1ZpBAKS01738355528.png\" width=\"328\"/><br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Possible bone expansion and <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> thinning <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Malignant Transformation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Risk of secondary <span class=\"customMeta\" data-dictid=\"85f406df3716927771841792cc4458\">chondrosarcoma</span> &gt; 50% <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Similar timing for <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> transformation as Ollier's disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased risk for carcinomas (breast, liver, ovary) <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:585px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiographic Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large chondromas visible on X-rays</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histological Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Higher <span class=\"customMeta\" data-dictid=\"aed7aaaa4516927771844cded86cdb\">cellularity</span> and proliferative potential compared to <span class=\"customMeta\" data-dictid=\"9729ba172a1692777198c816c4ad9c\">solitary</span> chondromas</p>\n<img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"439\" src=\"https://image.prepladder.com/content/N08TD92sIe9HYGWpoqQx1738355648.png\" width=\"860\"/><br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Malignant Transformation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Concern for secondary <span class=\"customMeta\" data-dictid=\"82068425041692777198fe3064c370\">sarcoma</span> in both conditions</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Signs:</strong></p>\n<p>Increase in <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> size</p>\n<p>New symptoms (e.g., pain)</p>\n<p>MRI evidence of new soft-tissue mass</p>\n<p>Histological permeative growth pattern</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/cdSN0F5CeNaPfGgwiAEZ1738355433.png\" width=\"1077\"/></p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extra-skeletal Malignancies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Higher risk for tumors in breast, liver, ovaries, CNS</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/S34S8hxEQ3eUJ2idR9jC1743851194.mp3", "video": ""}, {"text": "A 30-year-old male is diagnosed with a chondroma following imaging and histological examination. Which of the following statements regarding chondromas is false?", "options": [{"label": "A", "text": "Chondromas are generally slow-growing, ceasing post-skeletal maturity.", "correct": false}, {"label": "B", "text": "Most chondromas are symptomatic and present with pain or fractures.", "correct": true}, {"label": "C", "text": "Chondromas commonly occur in the tubular bones of the hand.", "correct": false}, {"label": "D", "text": "Serial X-rays can help monitor for malignant transformation in chondromas.", "correct": false}], "correct_answer": "B. Most chondromas are symptomatic and present with pain or fractures.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/VIGPoOUQLEJOUDkusCbT1738355286.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Predominantly found in <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> bones of the hand. <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Other common sites include the <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> and humerus.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mostly asymptomatic; often discovered via radiography.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May cause pain or <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">pathological</span> fractures in some cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Growth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generally slow-growing, ceasing post-skeletal maturity. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"7\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Malignant Transformation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically benign, but <span class=\"customMeta\" data-dictid=\"55a682d72e16927771865bb4855ba3\">differentiation</span> from <span class=\"customMeta\" data-dictid=\"5297b5833216927771910b7a85de53\">low-grade</span> <span class=\"customMeta\" data-dictid=\"85f406df3716927771841792cc4458\">chondrosarcoma</span> (grade 1) is challenging.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Indicators of <span class=\"customMeta\" data-dictid=\"85f406df3716927771841792cc4458\">chondrosarcoma</span> include:</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased cellularity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enlarged nuclei</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presence of multiple double-nucleated cells</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infiltration into <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> spaces and <span class=\"customMeta\" data-dictid=\"b0c8b025fd16927771881cceae546d\">haversian</span> system</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Serial <span class=\"customMeta\" data-dictid=\"6fda63a90c1692777202563d33a81b\">X-rays</span> are useful for monitoring potential malignancy; growth post-skeletal <span class=\"customMeta\" data-dictid=\"ba06b6179a16927771925370a2760c\">maturity</span> may signal transformation. <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/PU7LdHqqVzK59Ql1mJeI1743850992.mp3", "video": ""}, {"text": "A 25-year-old male presents with a bony swelling near his knee. He denies pain or any recent trauma. X-ray shows a pedunculated bony outgrowth growing away from the joint, with a thin outer cortex and cancellous structure. What is the next step in management?", "options": [{"label": "A", "text": "Immediate excision", "correct": false}, {"label": "B", "text": "Observation and follow-up", "correct": true}, {"label": "C", "text": "Biopsy to rule out malignancy", "correct": false}, {"label": "D", "text": "MRI to assess the cartilage cap thickness", "correct": false}], "correct_answer": "B. Observation and follow-up", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/5Pr82iNGeMjGr5UhoqWo1738355161.png", "https://image.prepladder.com/content/i5u0wGJcUt7GxP5jr8Vt1738354961.png", "https://image.prepladder.com/content/qNdVPsW8CROUvCrlIeoe1738354862.png"], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Reference:</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Painful <span class=\"customMeta\" data-dictid=\"305c26a07b1692777183e163c48e3c\">bursa</span> formation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Due to <span class=\"customMeta\" data-dictid=\"468709afe3169277720301878d09fd\">friction</span> over the osteochondroma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Activity-related discomfort</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>General discomfort with movement.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nerve compression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare, may cause neuropathic symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uncommon, results in sudden pain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Malignant transformation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> to chondrosarcoma, more likely with a <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> cap &gt;1.5 cm.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/m1Qj9muEj4txe1DwSa0P1743850854.mp3", "video": ""}, {"text": "A 14-year-old male presents with a painless, hard mass near his proximal humerus. Imaging reveals a bony protuberance with a well-defined cortex that flares into the lesion. Which of the following radiographic features is most indicative of osteochondroma?", "options": [{"label": "A", "text": "Sclerotic margins with central lucency", "correct": false}, {"label": "B", "text": "Cortical flaring into the lesion", "correct": true}, {"label": "C", "text": "Irregular spiculated margins", "correct": false}, {"label": "D", "text": "Joint erosion adjacent to the lesion", "correct": false}], "correct_answer": "B. Cortical flaring into the lesion", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/gf6Buro5AW6reRheRKvD1738354500.png", "https://image.prepladder.com/content/u799A96QtsIH3XF6bkE71738354549.png", "https://image.prepladder.com/content/taVwix4iyGQplAYhoLea1738354785.png", "https://image.prepladder.com/notes/y8e49oPNYdpPsfNJyNMd1743680718.png", "https://image.prepladder.com/content/IcwL84WZBYkBWyssrdtP1738354607.png", "https://image.prepladder.com/content/omzWaV3y2cYykRGK56tk1738354406.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk of <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">Malignant</span> Transformation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Solitary Osteochondroma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low risk (~1%). Difficult to determine exact incidence.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"791\" src=\"https://image.prepladder.com/content/u799A96QtsIH3XF6bkE71738354549.png\" width=\"500\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>~1%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Multiple Osteochondromas (MO)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Higher risk (~4%). Autosomal dominant disorder with EXT1 or EXT2 gene mutations in 90% of cases.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"319\" src=\"https://image.prepladder.com/content/taVwix4iyGQplAYhoLea1738354785.png\" width=\"500\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>~4%</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Wsh7MPk9xFp4TmadQp6T1743850291.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 35 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 27</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Bone Tumors-Previous Year Questions - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 27</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 27 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 20-year-old male patient presented with localized pain, which is gradual in onset and worsened over time. X-ray showed the following finding. What is the diagnosis?", "options": [{"label": "A", "text": "Osteosarcoma", "correct": true}, {"label": "B", "text": "Ewing sarcoma", "correct": false}, {"label": "C", "text": "Chondrosarcoma", "correct": false}, {"label": "D", "text": "Gout", "correct": false}], "correct_answer": "A. Osteosarcoma", "question_images": ["https://image.prepladder.com/content/k1uA6n8wczOZOfLcBr761741058451.png"], "explanation_images": ["https://image.prepladder.com/content/BJCDTsXfCE7Lr7WDJXo91741058567.png", "https://image.prepladder.com/content/K1XAuTM1yB4RiZdTwFL81741058609.png", "https://image.prepladder.com/content/k1uA6n8wczOZOfLcBr761741058451.png", "https://image.prepladder.com/content/ADfGkyLin0Bi82sdfaXl1741058724.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the following condition", "options": [{"label": "A", "text": "Osteosarcoma", "correct": true}, {"label": "B", "text": "Ewing sarcoma", "correct": false}, {"label": "C", "text": "Osteiod Osteoma", "correct": false}, {"label": "D", "text": "GCT", "correct": false}], "correct_answer": "A. Osteosarcoma", "question_images": ["https://image.prepladder.com/content/7ym7RI1GJN0Ks04TfND31747033978.png"], "explanation_images": ["https://image.prepladder.com/content/6mNrr1XPK1amUoiDPhLn1748153681.png", "https://image.prepladder.com/content/vDZmEudyV8MsgkgIcxXL1748153714.png", "https://image.prepladder.com/content/YKjlej3zXmjKRdb9PSrX1748153753.png", "https://image.prepladder.com/content/kybHSZ945AvKGVZDJu6I1748153762.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35 year old man presented with a gradual progressive swelling, and was diagnosed with Adamantinoma. Which of the following bones is typically affected by this tumor?", "options": [{"label": "A", "text": "Radius", "correct": false}, {"label": "B", "text": "Humerus", "correct": false}, {"label": "C", "text": "Femur", "correct": false}, {"label": "D", "text": "Tibia", "correct": true}], "correct_answer": "D. Tibia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Adamantinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>About</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rare, <span class=\"customMeta\" data-dictid=\"5297b5833216927771910b7a85de53\">low-grade</span> <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> bone tumors of uncertain histogenesis</li>\n<li>Commonly affects the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"8ccb80bd4d169277719296d80e2193\">metaphysis</span> and <span class=\"customMeta\" data-dictid=\"604558eae21692777186613f3915a9\">diaphysis</span> tibia, close to the skin surface.</li>\n<li>Immunohistochemical studies suggest epithelial origin.</li>\n<li>Commonly affects individuals aged 20-40 years.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Macroscopic:</strong> Well-defined, <span class=\"customMeta\" data-dictid=\"61f84221371692777191a8e70c449c\">lobulated</span> <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> tumors with yellowish-gray appearance and possible <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> spaces.</li>\n<li><strong>Microscopic:</strong> Biphasic composition (epithelial and osteofibrous components) with basaloid, tubular, spindle-cell, squamous, and osteofibrous dysplasia-like patterns.</li>\n<li><strong>Immunohistochemistry:</strong>\n<ul>\n<li>Epithelial cells: Positive for keratin, EMA, vimentin, p63, podoplanin.</li>\n<li>Fibrous component: Positive for vimentin.</li>\n<li>Expression of EGF, EGFR (epithelial), FGF2, FGFR1 (both components).</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prolonged clinical course with slow-growing swelling, possible pain, bone deformities, or <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">pathological</span> fractures (~23%).</li>\n<li>Rarely involves neurological deficits when the spine is affected.</li>\n<li>Metastases commonly involve lungs, <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, or spine.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>X-ray:</strong> Well-circumscribed, multilobulated, osteolytic <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> tumor with a \"soap-bubble\" appearance.</li>\n<li><strong>CT Scan:</strong> Assesses soft tissue extension and <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> involvement.</li>\n<li><strong>MRI:</strong> Locoregional staging; visualizes tumor margins, <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> involvement, and soft tissue extension.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Wide Resection: </strong>En bloc removal with wide margins preferred.</li>\n<li><strong>Metastasectomy: </strong>First-line for <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> recurrences.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 30-year-old female who presents with a tumor located at the knee joint, as shown in the provided biopsy-image?", "options": [{"label": "A", "text": "Osteosarcoma", "correct": false}, {"label": "B", "text": "Ewing’s Sarcoma", "correct": false}, {"label": "C", "text": "Giant cell tumour", "correct": true}, {"label": "D", "text": "Osteoblastoma", "correct": false}], "correct_answer": "C. Giant cell tumour", "question_images": ["https://image.prepladder.com/content/EDKfd6d6pUkyj03gTcMh1745219868.png"], "explanation_images": ["https://image.prepladder.com/content/g7xoftwUokm4hpPdT2ca1745219933.png", "https://image.prepladder.com/content/zuFurNwY3LPc2evAx8PW1745219940.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Benign but locally aggressive tumor of bone.<strong> </strong></li>\n<li>It commonly arises from epiphysis.</li>\n<li>MC Age: 20 and 45 years of age.</li>\n<li>Females &gt; males.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sites affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Distal <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> &gt; Proximal <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> &gt; Distal <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> &gt; Sacrum</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Malignant transformation in &lt;1% of cases.</li>\n<li>Lungs are the most common site for metastases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Swelling, vague pain.</li>\n<li>Pathological fracture.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>X-ray: Expansile <span class=\"customMeta\" data-dictid=\"897ef2d27c16927771861eb7f4726c\">eccentric</span> <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> on epiphysis</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Luu Hanh\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/giant-cell-tumour-with-secondary-aneurysmal-bone-cyst-3\" data-tags=\"\" height=\"602\" src=\"https://image.prepladder.com/content/g7xoftwUokm4hpPdT2ca1745219933.png\" width=\"541\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histo- pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Multinucleated giant cells and a background network of spindle-shaped <span class=\"customMeta\" data-dictid=\"81ec3329d0169277719261f4b61d44\">mononuclear</span> stromal cells.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC-BY-SA-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Giant_cell_tumour_of_bone_-_very_high_mag.jpg\" data-tags=\"\" height=\"381\" src=\"https://image.prepladder.com/content/zuFurNwY3LPc2evAx8PW1745219940.png\" width=\"569\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Extended <span class=\"customMeta\" data-dictid=\"f857ee35331692777185a5895e53b5\">curettage</span> with Bone grafting</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old boy is experiencing pain in the area surrounding his knee joint. The following lesion visible on the X-ray is seen extending from the distal femur to the terminal end. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Giant cell tumour", "correct": false}, {"label": "B", "text": "Chondroblastoma", "correct": false}, {"label": "C", "text": "Osteoid osteoma", "correct": false}, {"label": "D", "text": "Osteosarcoma", "correct": true}], "correct_answer": "D. Osteosarcoma", "question_images": ["https://image.prepladder.com/notes/b6olhzhFs0GbQvjaXOOw1746519809.png"], "explanation_images": ["https://image.prepladder.com/notes/Pw8aq1dsC6CBQbiHzAJ51746621396.png", "https://image.prepladder.com/notes/6Jutgrxil2EDyoAG810s1746520174.png", "https://image.prepladder.com/notes/jYOV2KlYuPHBe5o5CnSb1746520199.png", "https://image.prepladder.com/notes/1VUW1IiZrkLXMnZNDgcq1746520301.png", "https://image.prepladder.com/notes/Lo9rPTWqiZyGAbehpt5b1746520327.png"], "explanation": "<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"text-align:center\"><strong>Types base on Clinical Setting </strong></td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Primary osteosarcoma </strong></p>\n<ul>\n<li>No known pre-malignant conditions related to it. </li>\n<li>Age group: 15-25 years</li>\n</ul>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Secondary osteosarcoma </strong></p>\n<ul>\n<li>Pre-malignant conditions are often associated with it. </li>\n<li>Paget's disease, multiple enchondromatosis, <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> dysplasia, <span class=\"customMeta\" data-dictid=\"35bafad73816927771904e162f4a70\">irradiation</span> to bones, multiple osteochondroma. </li>\n<li>Older age group</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year old male with gradual progressive swelling around his wrist joint for 3 months. Image of the swelling on the x-ray film is given below. What is the probable diagnosis?", "options": [{"label": "A", "text": "Osteosarcoma", "correct": false}, {"label": "B", "text": "Ewing’s Sarcoma", "correct": false}, {"label": "C", "text": "Osteoclastoma", "correct": true}, {"label": "D", "text": "Osteochondroma", "correct": false}], "correct_answer": "C. Osteoclastoma", "question_images": ["https://image.prepladder.com/notes/3gcY2kPhmAPVniJ7WvLu1746428642.png", "https://image.prepladder.com/notes/TXx3y0LyhucorOcNL99E1746428681.png"], "explanation_images": ["https://image.prepladder.com/notes/3gcY2kPhmAPVniJ7WvLu1746428642.png", "https://image.prepladder.com/notes/TXx3y0LyhucorOcNL99E1746428681.png", "https://image.prepladder.com/notes/ZEqUMY4SZ8trCmid1Kim1746428967.png", "https://image.prepladder.com/content/LSwWBCFJDKLpX6E2gSjq1745393240.png", "https://image.prepladder.com/content/z10Lst7mwjM9H8EqWQKo1745393273.png", "https://image.prepladder.com/content/8iIvWKjTdLoMzltOy8oN1745393309.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Benign but locally aggressive tumor of bone.<strong> </strong></li>\n<li>It commonly arises from epiphysis.</li>\n<li>MC Age: 20 and 45 years of age.</li>\n<li>Females &gt; males.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sites affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Distal <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> &gt; <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> &gt; <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> &gt; sacrum.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Malignant transformation in &lt;1% of cases.</li>\n<li>Lungs are the most common site for metastases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Swelling, vague pain.</li>\n<li>Pathological fracture.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Osteoclastoma\" data-author=\"Raveenthiran Venkatachalam, Vincent Mangayarkarasi, Murugesan Kousalya, Periyaswamy Viswanathan, Manivachagam Dhanalakshmi, Viswanathan Anandi\" data-hash=\"11723\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Subcutaneous-Entomophthoromycosis-of-the-right-wrist-mimicking-osteoclastoma_fig3_273785875\" data-tags=\"May2025\" height=\"254\" src=\"https://image.prepladder.com/notes/3gcY2kPhmAPVniJ7WvLu1746428642.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>X-ray: Expansile <span class=\"customMeta\" data-dictid=\"897ef2d27c16927771861eb7f4726c\">eccentric</span> <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> on epiphysis</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Osteoclastoma - Xray\" data-author=\"Amini B, MacManus D, Le L, et al.\" data-hash=\"11726\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/giant-cell-tumour-of-bone\" data-tags=\"May2025\" height=\"261\" src=\"https://image.prepladder.com/notes/TXx3y0LyhucorOcNL99E1746428681.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histo- pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Multinucleated giant cells and a background network of spindle-shaped <span class=\"customMeta\" data-dictid=\"81ec3329d0169277719261f4b61d44\">mononuclear</span> stromal cells.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Osteoclastoma Histopathology\" data-author=\"Nephron\" data-hash=\"11730\" data-license=\"CC-BY-SA-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Giant_cell_tumour_of_bone_-_very_high_mag.jpg\" data-tags=\"May2025\" height=\"212\" src=\"https://image.prepladder.com/notes/ZEqUMY4SZ8trCmid1Kim1746428967.png\" width=\"316\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Extended <span class=\"customMeta\" data-dictid=\"f857ee35331692777185a5895e53b5\">curettage</span> with Bone grafting</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following with their most appropriate mode of management: 1. Osteosarcoma 2. Simple bone cyst 3. Giant cell tumor 4. Osteoid osteoma A. Wide excision B. Curettage C. Radiofrequency ablation D. Intralesional steroid", "options": [{"label": "A", "text": "1-d, 2-c, 3-b, 4-a", "correct": false}, {"label": "B", "text": "1-c, 2-a, 3-d, 4-b", "correct": false}, {"label": "C", "text": "1-a, 2-d, 3-b, 4-c", "correct": true}, {"label": "D", "text": "1-d, 2-a, 3-b, 4-c", "correct": false}], "correct_answer": "C. 1-a, 2-d, 3-b, 4-c", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/N6SA81KGOn9pkdAvsLTG1746432669.png", "https://image.prepladder.com/notes/6D8YRa5CkSDegqN6dPd81746432705.png", "https://image.prepladder.com/notes/eqYmm6QVo7gmpx4X5V9U1746432746.png", "https://image.prepladder.com/notes/OY6xiaFBMBEVFBUQxuyB1746432821.png", "https://image.prepladder.com/notes/zHtbKIJeUJQn0noyP15I1746432858.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:678px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features and Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Osteosarcoma</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"ortho\" data-author=\"Bilal Mujtaba ,Ahmed Taher ,Matthew J. Fiala ,Rizwan Aslam\" data-hash=\"11788\" data-license=\"CC BY-NC-ND\" data-source=\"https://www.researchgate.net/figure/The-sunburst-appearance-with-cloudlike-density-of-untreated-Osteosarcoma-is-observed-in_fig7_336065799\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/N6SA81KGOn9pkdAvsLTG1746432669.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> bone tumor, commonly affecting the <span class=\"customMeta\" data-dictid=\"88df1fa4461692777192ca48ef701b\">metaphyses</span> of long bones (e.g., femur, tibia).</li>\n<li>It most frequently occurs in adolescents and young adults. Symptoms include pain, swelling, and sometimes a <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> mass.</li>\n<li>X-rays typically show a sunburst appearance with mixed <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> and <span class=\"customMeta\" data-dictid=\"934e9f88af169277719847f1a0728f\">sclerotic</span> areas.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Surgical <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> (amputation or limb-sparing surgery), followed by chemotherapy.</li>\n<li>Radiation therapy is rarely used.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Simple Bone <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">Cyst</span> </strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"ortho\" data-author=\"Stanislavsky A, Elfeky M, Bickle I, et al.\" data-hash=\"11789\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/fallen-fragment-sign\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/6D8YRa5CkSDegqN6dPd81746432705.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A benign, fluid-filled cyst, often occurring in the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> or femur.</li>\n<li>It is typically asymptomatic</li>\n<li>On X-ray, it appears as a well-defined, <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> with a thin <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> rim.</li>\n<li>Often occurs in children and adolescents.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Aspiration and <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> injection, or <span class=\"customMeta\" data-dictid=\"f857ee35331692777185a5895e53b5\">curettage</span> with bone <span class=\"customMeta\" data-dictid=\"6ca773c032169277718858b8ad1e9c\">grafting</span> if <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> fractures occur.</li>\n<li>Surgical intervention is usually necessary if there is risk of fracture.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Giant Cell Tumor </strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"ortho\" data-author=\"Luu Hanh\" data-hash=\"11790\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/giant-cell-tumour-with-secondary-aneurysmal-bone-cyst-3\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/eqYmm6QVo7gmpx4X5V9U1746432746.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A benign, locally aggressive tumor that typically occurs in the <span class=\"customMeta\" data-dictid=\"0fa073bd8016927771872ee5b57674\">epiphysis</span> of long bones (e.g., <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> femur, <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> tibia).</li>\n<li>It is most common in young adults.</li>\n<li>Symptoms include pain, swelling, and sometimes joint dysfunction.</li>\n<li>X-rays show a <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> with a \"soap bubble\" appearance.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Curettage with bone <span class=\"customMeta\" data-dictid=\"6ca773c032169277718858b8ad1e9c\">grafting</span> or chemical adjuvants (e.g., phenol). Wide <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> for larger or more aggressive tumors..</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Osteoid Osteoma</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"ortho\" data-author=\"Adlan, Amirul &amp; Azzopardi, Christine &amp; Davies, Mark &amp; James, Steven &amp; Botchu, R\" data-hash=\"11791\" data-license=\"CC BY-NC-ND 4.0\" data-source=\"https://www.researchgate.net/figure/Right-leg-anteroposterior-radiograph-showing-osteoid-osteoma-arrow-with-marked-cortical_fig1_361999794\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/OY6xiaFBMBEVFBUQxuyB1746432821.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"ortho\" data-author=\"NA\" data-hash=\"11794\" data-license=\"NA\" data-source=\"NA\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/zHtbKIJeUJQn0noyP15I1746432858.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> bone tumor that most commonly affects the <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> or tibia. It typically occurs in adolescents or young adults.</li>\n<li>Characterized by a small, well-circumscribed <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> with a central <span class=\"customMeta\" data-dictid=\"00375928541692777193ce8621da42\">nidus</span> on X-ray.</li>\n<li>Symptoms include <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> pain, especially at night, that is relieved by NSAIDs.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> of the <span class=\"customMeta\" data-dictid=\"00375928541692777193ce8621da42\">nidus</span> is the standard treatment. Radiofrequency <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">ablation</span> can be used</li>\n<li>Pain is often well-controlled with NSAIDs until <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> treatment.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year old male with gradual progressive swelling around his wrist joint for 3 months. Image of the swelling on the x-ray film is given below. What is the probable diagnosis?", "options": [{"label": "A", "text": "Osteosarcoma", "correct": false}, {"label": "B", "text": "Ewing’s Sarcoma", "correct": false}, {"label": "C", "text": "Osteoclastoma", "correct": true}, {"label": "D", "text": "Osteochondroma", "correct": false}], "correct_answer": "C. Osteoclastoma", "question_images": ["https://image.prepladder.com/content/hTolPO4PIjVTnJZneFbD1747907762.png", "https://image.prepladder.com/content/qzhmIFZIYuK1L2ggIRNY1747907805.png", "https://image.prepladder.com/content/JB56hTQVRRj7sC7r3Xmp1747907678.png"], "explanation_images": ["https://image.prepladder.com/content/BkFxYvoU0Tl6kmk29o9B1747907664.png", "https://image.prepladder.com/content/RcL3hmxjQvUZNHhfJjsY1747907832.png", "https://image.prepladder.com/content/QjOlVESB2ghu2WMOkng01747907916.png", "https://image.prepladder.com/content/CKo9nx01cIHFKluRSzLF1747907928.png", "https://image.prepladder.com/content/zb8hl1rDAEjRHbtH4TBf1747907939.png", "https://image.prepladder.com/content/PSe5r51UkmzsgAKQateN1747907946.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Benign but locally aggressive tumor of bone.<strong> </strong></li>\n<li>It commonly arises from epiphysis.</li>\n<li>MC Age: 20 and 45 years of age.</li>\n<li>Females &gt; males.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sites affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Distal <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> &gt; <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> &gt; <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> &gt; sacrum.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Malignant transformation in &lt;1% of cases.</li>\n<li>Lungs are the most common site for metastases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Swelling, vague pain.</li>\n<li>Pathological fracture.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Raveenthiran Venkatachalam, Vincent Mangayarkarasi, Murugesan Kousalya, Periyaswamy Viswanathan, Manivachagam Dhanalakshmi, Viswanathan Anandi\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Subcutaneous-Entomophthoromycosis-of-the-right-wrist-mimicking-osteoclastoma_fig3_273785875\" data-tags=\"\" height=\"6945\" src=\"https://image.prepladder.com/content/BkFxYvoU0Tl6kmk29o9B1747907664.png\" width=\"5463\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>X-ray: Expansile <span class=\"customMeta\" data-dictid=\"897ef2d27c16927771861eb7f4726c\">eccentric</span> <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> on epiphysis</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Amini B, MacManus D, Le L, et al.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/giant-cell-tumour-of-bone\" data-tags=\"\" height=\"6801\" src=\"https://image.prepladder.com/content/RcL3hmxjQvUZNHhfJjsY1747907832.png\" width=\"5208\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histo- pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Multinucleated giant cells and a background network of spindle-shaped <span class=\"customMeta\" data-dictid=\"81ec3329d0169277719261f4b61d44\">mononuclear</span> stromal cells.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC-BY-SA-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Giant_cell_tumour_of_bone_-_very_high_mag.jpg\" data-tags=\"\" height=\"1098\" src=\"https://image.prepladder.com/content/QjOlVESB2ghu2WMOkng01747907916.png\" width=\"1639\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Extended <span class=\"customMeta\" data-dictid=\"f857ee35331692777185a5895e53b5\">curettage</span> with Bone grafting</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female patient presented with complaints of a gradually progressive swelling around her wrist joint for 3 months. Given below is the image of the X-ray film. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Osteosarcoma", "correct": false}, {"label": "B", "text": "Ewing’s Sarcoma", "correct": false}, {"label": "C", "text": "Osteoclastoma", "correct": true}, {"label": "D", "text": "Osteochondroma", "correct": false}], "correct_answer": "C. Osteoclastoma", "question_images": ["https://image.prepladder.com/notes/YxwBhktcXIxPgGjzk2jF1747917083.png"], "explanation_images": ["https://image.prepladder.com/notes/YxwBhktcXIxPgGjzk2jF1747917083.png", "https://image.prepladder.com/notes/YNeH66s71VqBNuPmSlXZ1747917154.png", "https://image.prepladder.com/notes/XY1AAof8xyRDju43cabT1747917215.png", "https://image.prepladder.com/notes/6u4qopbUwMg9bzIEmvOX1747917276.png", "https://image.prepladder.com/notes/L0jQL6YtYmg9vhVEU8Ln1747917351.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Benign but locally aggressive tumor of bone.<strong> </strong></li>\n<li>It commonly arises from epiphysis.</li>\n<li>MC Age: 20 and 45 years of age.</li>\n<li>Females &gt; males.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sites affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Distal <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> &gt; <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> &gt; <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> &gt; sacrum.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Malignant transformation in &lt;1% of cases.</li>\n<li>Lungs are the most common site for metastases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Swelling, vague pain.</li>\n<li>Pathological fracture.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>X-ray: Expansile <span class=\"customMeta\" data-dictid=\"897ef2d27c16927771861eb7f4726c\">eccentric</span> <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> on epiphysis</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Osteoclastoma Xray\" data-author=\"Amini B, MacManus D, Le L, et al.\" data-hash=\"13209\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/giant-cell-tumour-of-bone\" data-tags=\"May2025\" height=\"522\" src=\"https://image.prepladder.com/notes/YxwBhktcXIxPgGjzk2jF1747917083.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histo- pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Multinucleated giant cells and a background network of spindle-shaped <span class=\"customMeta\" data-dictid=\"81ec3329d0169277719261f4b61d44\">mononuclear</span> stromal cells.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"Osteoclastoma Histopathology\" data-author=\"Nephron\" data-hash=\"13210\" data-license=\"CC-BY-SA-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Giant_cell_tumour_of_bone_-_very_high_mag.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/YNeH66s71VqBNuPmSlXZ1747917154.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Extended <span class=\"customMeta\" data-dictid=\"f857ee35331692777185a5895e53b5\">curettage</span> with Bone grafting</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old man presented with knee pain. The x-ray of his knee joint is given below. What is the probable diagnosis?", "options": [{"label": "A", "text": "Chondroblastoma", "correct": false}, {"label": "B", "text": "Osteochondroma", "correct": false}, {"label": "C", "text": "Osteoclastoma", "correct": true}, {"label": "D", "text": "Fibrous dysplasia", "correct": false}], "correct_answer": "C. Osteoclastoma", "question_images": ["https://image.prepladder.com/notes/JtS7LLlTxalviNsZ4hSO1745261449.png"], "explanation_images": ["https://image.prepladder.com/notes/MAqMGed1B3F1mcAzz7s11745261553.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old patient presents with painful swelling in the index finger around the proximal phalanx. An X-ray was done, and it is shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Osteosarcoma", "correct": false}, {"label": "B", "text": "Ewing's Sarcoma", "correct": false}, {"label": "C", "text": "Osteoclastoma", "correct": false}, {"label": "D", "text": "Enchondroma", "correct": true}], "correct_answer": "D. Enchondroma", "question_images": ["https://image.prepladder.com/content/XKkZSQmkQtlHqFtANK211746179533.png"], "explanation_images": ["https://image.prepladder.com/content/6XTiEnPGfuJX8zbnoovZ1746179567.png", "https://image.prepladder.com/content/dE6m89Ab9DAPLbdw1kJs1746179601.png", "https://image.prepladder.com/content/m62EPiVgFlQuNGaNOqJV1746179601.png", "https://image.prepladder.com/content/YEBbqIvgbGQgOYX5EfLY1746179601.png", "https://image.prepladder.com/content/N68FTz7awDH1MP1wyjXT1746179601.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Fracture after trivial fall in elderly patient. Identify the cause?", "options": [{"label": "A", "text": "Bone metastasis", "correct": true}, {"label": "B", "text": "TB hip", "correct": false}, {"label": "C", "text": "Brown tumour", "correct": false}, {"label": "D", "text": "Eosinophilic granuloma", "correct": false}], "correct_answer": "A. Bone metastasis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:620px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Common Metastatic Tumors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Lung <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> (male)</li>\n<li>Breast <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> (female)</li>\n<li>Prostate <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> <strong>(Osteoblastic)</strong></li>\n<li>Thyroid carcinoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Clinical Features</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Known Primary Malignancy:\n\t\t\t\t<ul>\n<li>Bone pain (common in spine, ribs, extremities)</li>\n<li>Pathological <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> <strong>(common in spine and hip)</strong></li>\n</ul>\n</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li>Unknown Primary Malignancy:\n\t\t\t\t<ul>\n<li>Bone pain leading to destructive <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> diagnosis</li>\n<li>Pathological <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> due to weakened bone</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Malignancies Presenting with Silent Primary</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Thyroid carcinoma</li>\n<li>Renal cell carcinoma</li>\n<li>Bladder carcinoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Common Sites of Metastasis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Vertebral bodies</li>\n<li>Ribs</li>\n<li>Pelvis <strong>(Option A)</strong></li>\n<li>Humerus</li>\n<li>Femur</li>\n<li>Uncommon <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> to elbow and knee</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 22-year-old male presents with pain and swelling over the distal radius. X-ray shows an expansile lytic lesion in the metaphysis. Fine needle aspiration (FNA) reveals a bloody aspirate with hemosiderin-laden macrophages. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Giant cell tumor", "correct": false}, {"label": "B", "text": "Aneurysmal bone cyst", "correct": true}, {"label": "C", "text": "Osteosarcoma", "correct": false}, {"label": "D", "text": "Chondroblastoma", "correct": false}], "correct_answer": "B. Aneurysmal bone cyst", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aneurysmal Bone <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">Cyst</span> (ABC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Giant Cell Tumor (GCT)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primarily affects children and teenagers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most common in young adults (15-35 years)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gender</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Equal distribution between males and females</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More common in females (Female: Male ratio 1.5:1)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metaphyses</strong> of long bones (femur, tibia, humerus), spine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epiphyses</strong> of long bones (lower end of femur, upper end of tibia)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pain and swelling</strong>; <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> lesions may cause neurological issues</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Swelling without pain</strong>; late stages show joint limitation and <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">pathological</span> fracture</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>FNAC: <strong>Hemosiderin +</strong></li>\n<li>Blood-filled <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> spaces separated by <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> septae</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>FNAC: <strong>No hemosiderin</strong></li>\n<li>Abundant giant cells with multiple <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> (&gt;150), <span class=\"customMeta\" data-dictid=\"fc5f7fef0e169277719952d19a4532\">spindle</span> cells indicating malignancy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Osteolytic lesion, multiple septations and fluid-fluid levels on MRI</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thin <span class=\"customMeta\" data-dictid=\"d983a6cd671692777198ec423b3b90\">septa</span> with <strong>soap-bubble appearance</strong> on X-ray, <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> thin and expanded, no <span class=\"customMeta\" data-dictid=\"58c03304521692777195a054ce95e4\">periosteal</span> reaction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Curettage, debridement, and in some cases radiation (cautiously)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with PMMA or bone grafting; Denosumab and bisphosphonates as <span class=\"customMeta\" data-dictid=\"e405fcd2f2169277718034536f004a\">adjunct</span> therapy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Codman's triangle is seen in which of the following conditions?", "options": [{"label": "A", "text": "Osteomyelitis", "correct": false}, {"label": "B", "text": "Aneurysmal bone cyst", "correct": false}, {"label": "C", "text": "Osteogenic sarcoma", "correct": true}, {"label": "D", "text": "Chondrosarcoma", "correct": false}], "correct_answer": "C. Osteogenic sarcoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/UewOtbzMaaX7eqBso9921747657569.png", "https://image.prepladder.com/notes/RwlXaX9VDtlmOpPzpcF41747657587.png", "https://image.prepladder.com/content/zZz9WzkzIwLQKlIvN4Oe1747287195.png", "https://image.prepladder.com/content/zekqOBGeTBGn5Ini5HDc1747287195.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 17-year-old boy presents to the clinic complaining of a painless lump on the lateral aspect of his left knee. The radiograph of the patient is shown below. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Enchondroma", "correct": false}, {"label": "B", "text": "Osteosarcoma", "correct": false}, {"label": "C", "text": "Osteomyelitis", "correct": false}, {"label": "D", "text": "Osteochondroma", "correct": true}], "correct_answer": "D. Osteochondroma", "question_images": ["https://image.prepladder.com/content/pssDudiEUNLPywK8yKDo1747287759.png"], "explanation_images": ["https://image.prepladder.com/content/oarvikmxUDKq25pEaiCG1747287814.png", "https://image.prepladder.com/content/R69rAUAjoKktJHMA041k1747287860.png", "https://image.prepladder.com/content/ZaUPQ75nkyx1FIw2KyiA1747287866.png", "https://image.prepladder.com/content/3Xd6DB2H0Z9yNPQoQyx41747287884.png", "https://image.prepladder.com/content/SJMTReYzVPNJ3GgueXKv1747287903.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a complication of intermittent administration of teriparatide?", "options": [{"label": "A", "text": "Osteonecrosis of jaw", "correct": false}, {"label": "B", "text": "Net bone loss", "correct": false}, {"label": "C", "text": "Osteosarcoma", "correct": true}, {"label": "D", "text": "Subtrochanteric fracture of the femur", "correct": false}], "correct_answer": "C. Osteosarcoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"54093004eb169277719415bac43a91\"&gt;Osteosarcoma&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient has a painless, palpable bony mass near the metaphysis of a long bone . X-ray done shows the following finding. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Osteosarcoma", "correct": false}, {"label": "B", "text": "Multiple myeloma", "correct": false}, {"label": "C", "text": "Osteochondroma", "correct": true}, {"label": "D", "text": "Osteoid osteoma", "correct": false}], "correct_answer": "C. Osteochondroma", "question_images": ["https://image.prepladder.com/content/T2VsSqRkGyQyN53nZRhd1692690597.jpeg"], "explanation_images": ["https://image.prepladder.com/content/T2VsSqRkGyQyN53nZRhd1692690597.jpeg", "https://image.prepladder.com/content/nTALEOirPNXRx4OtX8pa1711617368.png", "https://image.prepladder.com/content/5GCgjszpyg8QMHFaeHKQ1711617358.png"], "explanation": "<p>Correct option C - Osteoch\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td> </td>\n<td><strong>X-ray finding</strong></td>\n</tr>\n<tr>\n<td><strong>Osteochondroma</strong></td>\n<td>\n<p>Bony outgrowth with a <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> cap</p>\n<p><img src=\"https://image.prepladder.com/content/T2VsSqRkGyQyN53nZRhd1692690597.jpeg\"/></p>\n</td>\n</tr>\n<tr>\n<td><strong>Osteosarcoma</strong></td>\n<td>\n<p>Destructive and <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> with aggressive features such as <span class=\"customMeta\" data-dictid=\"58c03304521692777195a054ce95e4\">periosteal</span> reaction, <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> destruction and soft tissue extension</p>\n<p><img src=\"https://image.prepladder.com/content/nTALEOirPNXRx4OtX8pa1711617368.png\" style=\"height:894px; width:651px\"/></p>\n</td>\n</tr>\n<tr>\n<td><strong>Multiple myeloma</strong></td>\n<td>Lytic lesions throughout the bone, often <span class=\"customMeta\" data-dictid=\"047f8930dd1692777197fed61e213c\">referred</span> to as \"punched-out\" lesions</td>\n</tr>\n<tr>\n<td><strong>Osteoid osteoma</strong></td>\n<td>\n<p>Small <span class=\"customMeta\" data-dictid=\"17825c11c616927771979bd9b0b285\">radiolucent</span> <span class=\"customMeta\" data-dictid=\"00375928541692777193ce8621da42\">nidus</span> surrounded by dense <span class=\"customMeta\" data-dictid=\"934e9f88af169277719847f1a0728f\">sclerotic</span> bone</p>\n<p><img src=\"https://image.prepladder.com/content/5GCgjszpyg8QMHFaeHKQ1711617358.png\" style=\"height:544px; width:381px\"/></p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 14 year old male presents with a mushroom like tumor in the distal femur for the past 2 years. Which of the following features suggest its malignant transformation?", "options": [{"label": "A", "text": "Thickness of cartilage cap &amp;gt; 2cm", "correct": true}, {"label": "B", "text": "Bone marrow is continuous with the parent bone", "correct": false}, {"label": "C", "text": "The cartilaginous growth goes towards the joint", "correct": false}, {"label": "D", "text": "Cartilage thickness &amp;gt; 3 cm", "correct": false}], "correct_answer": "A. Thickness of cartilage cap &gt; 2cm", "question_images": ["https://image.prepladder.com/content/MBiyOrwXGDUJ6NTJs7eb1744953158.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<ul>\n<li>Also known as Exostosis</li>\n<li>Most common primary <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> bone tumor (but not a true bone tumor)</li>\n<li>Benign <span class=\"customMeta\" data-dictid=\"a2a990a23c1692777183c6b47c7819\">cartilaginous</span> neoplasms arising from <span class=\"customMeta\" data-dictid=\"7e3052f7e41692777195a6e099781e\">physeal</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> beneath the periosteum.</li>\n<li>More common in <strong>males</strong>, usually appearing during <strong>adolescence</strong>.</li>\n<li>Affects long bones, <strong>lower end of <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> </strong>&gt; upper end of tibia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Solitary Osteochondroma</li>\n<li>Multiple Osteochondromas (MO)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Painless mass- most common presentation</li>\n<li>Pain: secondary to <span class=\"customMeta\" data-dictid=\"305c26a07b1692777183e163c48e3c\">bursa</span> formation/fracture/nerve compression</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Radiographic Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>X-ray: <strong>Pedunculated cauliflower-like mass</strong> originating from metaphysis</li>\n<li>MRI: used to assess <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> thickness</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Malignant transformation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Very rare</li>\n<li>MRI showing <strong>cartilage <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> &gt; 2 cms</strong> <strong>suggests <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> transformation (Option A)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Asymptomatic cases: No treatment required</li>\n<li>Symptomatic cases: <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">Excision</span> with biopsy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 17-year-old male patient who visits the clinic with a painless lump on the outer side of his left knee, as depicted in the radiograph provided?", "options": [{"label": "A", "text": "Enchondroma", "correct": false}, {"label": "B", "text": "Chondroblastoma", "correct": false}, {"label": "C", "text": "Osteochondroma", "correct": true}, {"label": "D", "text": "Giant cell tumor", "correct": false}], "correct_answer": "C. Osteochondroma", "question_images": ["https://image.prepladder.com/content/yuTsJBFYiNDgJPxzUG761746178694.png"], "explanation_images": ["https://image.prepladder.com/content/3e8SAMNfQhsIOk0GMJlY1746178748.png", "https://image.prepladder.com/content/YArvGjQ7VgZSB1QCg5PL1746178748.png", "https://image.prepladder.com/content/j5MQFJ44mtXBDuuR1IO81746178748.png", "https://image.prepladder.com/content/y6VfvG3VZRZqvERBhwkE1746178748.png", "https://image.prepladder.com/content/s71uI7mBjtJYenkpsysl1746178748.png", "https://image.prepladder.com/content/JDZn2tIgs47LvjVoW6181746178748.png", "https://image.prepladder.com/content/1qewvm5orYCmYRAAV9hB1746178748.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Painful <span class=\"customMeta\" data-dictid=\"305c26a07b1692777183e163c48e3c\">bursa</span> formation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Due to <span class=\"customMeta\" data-dictid=\"468709afe3169277720301878d09fd\">friction</span> over the osteochondroma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Activity-related discomfort</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>General discomfort with movement.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nerve compression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rare, may cause neuropathic symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uncommon, results in sudden pain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Malignant transformation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rare <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> to chondrosarcoma, more likely with a <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> cap &gt;1.5 cm.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old male patient presented with complaints of a gradually progressive swelling around his wrist joint for 3 months. Given below is the X-ray image of the affected wrist. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Ewing’s sarcoma", "correct": false}, {"label": "B", "text": "Osteosarcoma", "correct": false}, {"label": "C", "text": "Osteoclastoma", "correct": true}, {"label": "D", "text": "Osteochondroma", "correct": false}], "correct_answer": "C. Osteoclastoma", "question_images": ["https://image.prepladder.com/content/BzWthfjQOuj8VlzEWYSs1691220180.png"], "explanation_images": [], "explanation": "<p>Correct Option C - O\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with difficulty in walking. On biopsy of the hip , some cells with grooved nuclei and eosinophilic cytoplasm are present. Which investigation would you order next?", "options": [{"label": "A", "text": "MRI", "correct": false}, {"label": "B", "text": "Serum calcium", "correct": false}, {"label": "C", "text": "Serum PTH", "correct": false}, {"label": "D", "text": "CD1a marker", "correct": true}], "correct_answer": "D. CD1a marker", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - CD1a Mark\n<table>\n<tbody>\n<tr>\n<td>\n<p>Immunohistochemistry</p>\n</td>\n<td>\n<ul>\n<li>Helps identify the presence of specific markers, such as CD1a, Langerin, S-100 protein, which are characteristic of Langerhans cells</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Biopsy</p>\n</td>\n<td>\n<ul>\n<li>Confirms the diagnosis and identifies Langerhans cells in affected tissues. Can be performed on skin, bone, or other involved organs.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Imaging</p>\n</td>\n<td>\n<ul>\n<li>Evaluates the extent and involvement of organs. Common <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> modalities include</li>\n<li><strong>X-ray</strong>; SKULL: <span class=\"customMeta\" data-dictid=\"9729ba172a1692777198c816c4ad9c\">solitary</span> or multiple punched out <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> lesion, <span class=\"customMeta\" data-dictid=\"64f5c141d51692777188eb378afc37\">geographic</span> skull</li>\n<li>Spine: <span class=\"customMeta\" data-dictid=\"89cd4b5bf716927772010247b57941\">vertebra</span> plana</li>\n<li>Floating Tooth</li>\n<li><strong>Mandible:</strong> <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> <span class=\"customMeta\" data-dictid=\"17825c11c616927771979bd9b0b285\">radiolucent</span> area involving <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> alveolar bone.</li>\n<li> CT scan, MRI, and PET scan.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Complete blood count</p>\n</td>\n<td>\n<ul>\n<li>Detects abnormalities in blood cell counts, such as <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> or leukocytosis.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The treatment for the condition given below is:", "options": [{"label": "A", "text": "Extended curettage with allograft", "correct": false}, {"label": "B", "text": "Bone biopsy", "correct": false}, {"label": "C", "text": "Curettage", "correct": false}, {"label": "D", "text": "Extended curettage with autograft", "correct": true}], "correct_answer": "D. Extended curettage with autograft", "question_images": ["https://image.prepladder.com/content/uBmiEprmSbtF3zKY7YLb1695618521.png"], "explanation_images": [], "explanation": "<p>Correct Option D - Extended &lt;span class=\"customMeta\" data-dictid=\"f857ee35331692777185a5895e53b5\"&gt;Curettage&lt;/span&gt; with Autog\n<table>\n<tbody>\n<tr>\n<td><strong>Definition</strong></td>\n<td>\n<ul>\n<li>Giant Cell Tumor (GCT) of bone is a locally aggressive, potentially <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> <span class=\"customMeta\" data-dictid=\"1622f69a94169277719372b76236ca\">neoplasm</span> characterized by the presence of <span class=\"customMeta\" data-dictid=\"aa085932ce1692777193be7e5198bf\">multinucleated</span> giant cells and stromal cells. It typically occurs in the <span class=\"customMeta\" data-dictid=\"0fa073bd8016927771872ee5b57674\">epiphysis</span> (ends) of long bones.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Epidemiology</strong></td>\n<td>\n<ul>\n<li>Most commonly affects individuals between the ages of 20 and 40. - Slight female predilection.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Location</strong></td>\n<td>\n<ul>\n<li>Typically found in the <span class=\"customMeta\" data-dictid=\"8ccb80bd4d169277719296d80e2193\">metaphysis</span> (near the joint) of long bones, especially around the knee. - Common sites include the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> femur, <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> tibia, and <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> radius.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Pathogenesis</strong></td>\n<td>\n<ul>\n<li>The exact cause is not well understood, but there is a correlation with mutations in the H3F3A gene - Increased expression of <span class=\"customMeta\" data-dictid=\"cebebc510416927771979a104a1d7b\">RANKL</span> (Receptor <span class=\"customMeta\" data-dictid=\"a095f733351692777180a29940c98a\">Activator</span> of Nuclear Factor Kappa-B Ligand) plays a role in the pathogenesis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Clinical Presentation</strong></td>\n<td>\n<ul>\n<li><strong>Pain:</strong> Persistent pain at the site of the lesion, often worsening at night. - <strong>Swelling:</strong> <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">Localized</span> <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> or a <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> mass may be present. - <strong>Pathological Fractures:</strong> Weakening of the bone may lead to fractures.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Radiographic Features</strong></td>\n<td>\n<ul>\n<li><strong>Lytic Lesion:</strong> On X-rays, GCT appears as a <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> (lucent) <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> with well-defined borders. - <strong>Eccentric Location:</strong> Typically eccentrically located in the metaphysis, extending to the epiphysis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Histopathology</strong></td>\n<td>\n<ul>\n<li><strong>Giant Cells:</strong> Numerous <span class=\"customMeta\" data-dictid=\"aa085932ce1692777193be7e5198bf\">multinucleated</span> giant cells surrounded by <span class=\"customMeta\" data-dictid=\"81ec3329d0169277719261f4b61d44\">mononuclear</span> stromal cells. - <strong>Mitotic Activity:</strong> Variable, with higher mitotic activity suggesting a more aggressive course.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Diagnosis</strong></td>\n<td>\n<ul>\n<li>Imaging studies, including X-rays, CT scans, and MRI, help in initial diagnosis. - Confirmation through histopathological examination of a biopsy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Treatment</strong></td>\n<td>\n<ul>\n<li><strong>Curettage and Bone Grafting:</strong> Common <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> approach involving removal of the tumor and <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> the <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> with bone graft. - <strong>Denosumab:</strong> <span class=\"customMeta\" data-dictid=\"b2b82438d6169277719287eb450079\">Monoclonal</span> <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> therapy used in certain cases, particularly when surgery is challenging or to reduce recurrence. - <strong>En Bloc Resection:</strong> In cases of extensive involvement or recurrence.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Prognosis</strong></td>\n<td>\n<ul>\n<li>Generally good with appropriate treatment, but <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> is possible, especially in cases with incomplete excision.&lt;br&gt; - <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> is rare but can occur in aggressive cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Complications</strong></td>\n<td>\n<ul>\n<li><strong>Local Recurrence:</strong> More likely with incomplete excision. - <strong>Fractures:</strong> Weakening of bone may lead to <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">pathological</span> fractures. - <strong>Pulmonary Metastasis:</strong> Rare, but can occur in aggressive cases.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the following condition", "options": [{"label": "A", "text": "Osteosarcoma", "correct": true}, {"label": "B", "text": "Ewing sarcoma", "correct": false}, {"label": "C", "text": "Osteiod Osteoma", "correct": false}, {"label": "D", "text": "GCT", "correct": false}], "correct_answer": "A. Osteosarcoma", "question_images": ["https://image.prepladder.com/content/N5ZV0136R73L6iTRZcGD1700119176.png"], "explanation_images": [], "explanation": "<p>Correct Option A - O\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Radiological Findings</strong></p>\n</td>\n<td>\n<p><strong>Orthopedic <span class=\"customMeta\" data-dictid=\"d612c801d71692777194d0e00b8551\">Oncology</span> Conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Codman's triangle</p>\n</td>\n<td rowspan=\"2\">\n<p>Osteosarcoma</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Sunburst appearance</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Onion-skin appearance</p>\n</td>\n<td rowspan=\"2\">\n<p>Ewing's sarcoma</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Permeative bone destruction</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Cartilage-capped bony projection</p>\n</td>\n<td>\n<p>Osteochondroma</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Geode-like lesions</p>\n</td>\n<td>\n<p>Aneurysmal bone cyst</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Eccentric, soap-bubble appearance</p>\n</td>\n<td>\n<p>Chondroblastoma</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Expansile <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> with thin <span class=\"customMeta\" data-dictid=\"934e9f88af169277719847f1a0728f\">sclerotic</span> rim</p>\n</td>\n<td>\n<p>Simple bone cyst</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ground-glass appearance</p>\n</td>\n<td>\n<p>Fibrous dysplasia</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Soap-bubble appearance</p>\n</td>\n<td>\n<p>Giant cell tumor (osteoclastoma)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Well-defined <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> with <span class=\"customMeta\" data-dictid=\"934e9f88af169277719847f1a0728f\">sclerotic</span> margin</p>\n</td>\n<td>\n<p>Enchondroma</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Geographical pattern of bone destruction</p>\n</td>\n<td>\n<p>Metastatic bone lesions</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Multiple lucent lesions</p>\n</td>\n<td>\n<p>Multiple myeloma</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Linear, vertical, or <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">horizontal</span> striations</p>\n</td>\n<td>\n<p>Fibrosarcoma</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ill-defined, moth-eaten appearance</p>\n</td>\n<td>\n<p>Chondrosarcoma</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 18-year-old boy presents to the orthopedician with complaints of painful swelling below the knee joint. An X-Ray was obtained which is given below. Which of the following is the preferred treatment modality for this patient?", "options": [{"label": "A", "text": "Extended curettage and bone grafting", "correct": true}, {"label": "B", "text": "Simple curettage and bone grafting", "correct": false}, {"label": "C", "text": "Radiofrequency ablation", "correct": false}, {"label": "D", "text": "Radical excision", "correct": false}], "correct_answer": "A. Extended curettage and bone grafting", "question_images": ["https://image.prepladder.com/content/nx9IO73gzkWQ0IhxM76V1695560512.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35 year old man when presented with a gradual progressive swelling , was diagnosed with Adamantinoma. Which of the following bone is typically affected by this tumor?", "options": [{"label": "A", "text": "Radius", "correct": false}, {"label": "B", "text": "Humerus", "correct": false}, {"label": "C", "text": "Femur", "correct": false}, {"label": "D", "text": "Tibia", "correct": true}], "correct_answer": "D. Tibia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - T\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The following X-ray shows a lytic lesion of the lower limb . The biopsy shows fibroblastic proliferation, osteoclast and inflammatory cells. From the given options, the most likely diagnosis that can be inferred from the above clinical picture is", "options": [{"label": "A", "text": "Aneurysmal bone cyst", "correct": false}, {"label": "B", "text": "Giant cell tumor", "correct": true}, {"label": "C", "text": "Chondroblastoma", "correct": false}, {"label": "D", "text": "Langerhans cell histiocytosis", "correct": false}], "correct_answer": "B. Giant cell tumor", "question_images": ["https://image.prepladder.com/content/vJ2yMPsA1cWphBYeLbMw1688455966.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Giant Cell Tumou\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the potential diagnosis of the patient with a swelling around his knee, whose X-ray image is given below?", "options": [{"label": "A", "text": "Solitary bone cyst", "correct": false}, {"label": "B", "text": "Aneurysmal bone cyst", "correct": false}, {"label": "C", "text": "Giant cell tumor", "correct": true}, {"label": "D", "text": "Osteoblastoma", "correct": false}], "correct_answer": "C. Giant cell tumor", "question_images": ["https://image.prepladder.com/content/TJ5In0E9CggbzyDAui7b1700120905.png"], "explanation_images": [], "explanation": "<p>Correct Option C - Giant Cell Tu\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Osteogenic Sarcoma</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Osteoclastoma/Giant Cell Tumor</strong></p>\n</td>\n</tr>\n<tr>\n<td>Pain first, <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> next</td>\n<td>Swelling first, pain next </td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 37 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 16</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Bone And Imaging-Bone And Imaging-I - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 16</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 16 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the following forms the inorganic component of the extracellular matrix?", "options": [{"label": "A", "text": "Sialoproteins", "correct": false}, {"label": "B", "text": "Osteocalcin", "correct": false}, {"label": "C", "text": "Osteomectin", "correct": false}, {"label": "D", "text": "Hydroxyapatite", "correct": true}], "correct_answer": "D. Hydroxyapatite", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/NfFVigM3Qe3fTCIQIGNW1737707466.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:595px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type I collagen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type II <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Found in</p>\n<ul>\n<li>Bones</li>\n<li>Tendons</li>\n<li>Ligaments</li>\n<li>Menisci</li>\n<li>Annulus fibrosus of the <span class=\"customMeta\" data-dictid=\"95a8e326831692777190c5101eb835\">intervertebral</span> disc</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Found in</p>\n<ul>\n<li>Nucleus pulposus of the disc</li>\n<li>Hyaline <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> of joints</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/XnyqxvN34mcbPlga6Oim1744815089.mp3", "video": ""}, {"text": "Which of the following statements about the cellular components of the bone is true?", "options": [{"label": "A", "text": "Osteoclasts are responsible for mineral homeostasis", "correct": false}, {"label": "B", "text": "Osteoblasts are large multinucleated cells from mononuclear precursors", "correct": false}, {"label": "C", "text": "Osteocytes are mature osteoblasts residing encased in the matrix", "correct": true}, {"label": "D", "text": "Osteocytes are rich in alkaline phosphatase, glycolytic enzymes, and phosphorylases", "correct": false}], "correct_answer": "C. Osteocytes are mature osteoblasts residing encased in the matrix", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/GPpQxdSndPApRMgPOW9O1737707643.png", "https://image.prepladder.com/content/MKwvISdRkaXU8mXUK4kr1737707655.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:747px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Osteoblasts </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Osteocytes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Osteoclasts </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Derived from<strong> mesenchymal precursors</strong></li>\n<li>Influenced by growth factors (e.g., BMPs)</li>\n<li>Rich <strong>in <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> phosphatase, <span class=\"customMeta\" data-dictid=\"e55eb31d591692777188cb1fad1f5e\">glycolytic</span> enzymes, and phosphorylases </strong><strong>(Option D)</strong></li>\n<li>Produce <span class=\"customMeta\" data-dictid=\"946a9a6be11692777201eb269e8327\">type I</span> <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> and mineralize bone matrix</li>\n<li>Stimulated by PTH</li>\n<li>They can become quiescent lining cells or embedded as osteocytes after remodeling</li>\n<li>Decrease in number with ageing</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Osteocytes are <strong>derived from osteoblasts</strong> that become trapped within the <span class=\"customMeta\" data-dictid=\"14958c535b1692777192abd2a85abf\">matrix</span> they produce.</li>\n<li>They reside in bony <span class=\"customMeta\" data-dictid=\"47542020141692777191d94427da8f\">lacunae</span> and communicate with other osteocytes and surface-lining cells through long, thin <strong>cytoplasmic processes</strong>.</li>\n<li>Rich in <strong>glycogen and PAS-positive granules</strong></li>\n<li>Sensitive to mechanical stimuli</li>\n<li>Secrete sclerostin</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Large <span class=\"customMeta\" data-dictid=\"aa085932ce1692777193be7e5198bf\">multinucleated</span> cells from <strong>mononuclear precursors </strong><strong>(Option B)</strong></li>\n<li>It contains <span class=\"customMeta\" data-dictid=\"e55eb31d591692777188cb1fad1f5e\">glycolytic</span> acid hydrolases, collagenases, and acid phosphatase</li>\n<li><strong>Stimulated by RANKL</strong></li>\n<li>Have a foamy appearance</li>\n<li>The cell <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> forms a ruffled border for bone resorption</li>\n<li>Remain in<strong> Howship's lacunae</strong> post-resorption</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Function:</p>\n<ul>\n<li><strong>Bone formation</strong> (ossification)</li>\n<li>Production of non-collagenous protein, including <span class=\"customMeta\" data-dictid=\"015a35fa011692777194a06783f2a8\">Osteocalcin</span> &amp; Osteopontin</li>\n<li>Differentiation of Osteoclasts through RANK</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Function:</p>\n<ul>\n<li>Maintain connections to other osteocytes and osteoblasts</li>\n<li>Important for <strong>communication </strong>within bone tissue.</li>\n<li>Mineral <span class=\"customMeta\" data-dictid=\"50796581771692777189251fbe5ef1\">homeostasis</span> <strong>(Option A): </strong>Key role in <strong>phosphate homeostasis</strong> as a source of <span class=\"customMeta\" data-dictid=\"3095c5f0fc1692777202eda8060779\">Fibroblast</span> growth factor-23</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Function:</p>\n<ul>\n<li><strong>Bone resorption</strong></li>\n<li>Critical for bone remodelling</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/GPpQxdSndPApRMgPOW9O1737707643.png\" width=\"4167\"/></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\" BDB\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Osteocyte\" data-tags=\"\" height=\"2991\" src=\"https://image.prepladder.com/content/MKwvISdRkaXU8mXUK4kr1737707655.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/FbxGG5278Qurtcfp89QX1744815221.mp3", "video": ""}, {"text": "A 60-year-old woman has come to the orthopedic surgeon with bilateral knee pain and lower back pain. An X-ray reveals significant bone loss and osteoporosis. Which of the following markers would be raised in this patient?", "options": [{"label": "A", "text": "Bone-specific serum alkaline phosphatase", "correct": false}, {"label": "B", "text": "Serum osteocalcin", "correct": false}, {"label": "C", "text": "Serum peptide of type 1 collagen", "correct": false}, {"label": "D", "text": "Urine and serum cross-linked ‘N’ telopeptide", "correct": true}], "correct_answer": "D. Urine and serum cross-linked ‘N’ telopeptide", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/g9Fxobd3k0BsO0wxxcwG1743678398.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:679px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Markers of bone formation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Markers of bone resorption</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>By-products of <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> neosynthesis (e.g., propeptides of <span class=\"customMeta\" data-dictid=\"946a9a6be11692777201eb269e8327\">type I</span> collagen)</li>\n<li>Osteoblast-related proteins (e.g., osteocalcin, <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> phosphatase)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Related to <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> <span class=\"customMeta\" data-dictid=\"903370f259169277718385f6060dd7\">breakdown</span> products (e.g., hydroxyproline, <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> cross-links, telopeptides)</li>\n<li>Include non-collagenous <span class=\"customMeta\" data-dictid=\"14958c535b1692777192abd2a85abf\">matrix</span> proteins (e.g., bone sialoprotein)</li>\n<li>Enzymes specific to osteoclasts (e.g., tartrate-resistant acid phosphatase, <span class=\"customMeta\" data-dictid=\"56c3b320b41692777183118a784790\">cathepsin</span> K)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum:</strong></p>\n<ul>\n<li>Bone-specific <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> <span class=\"customMeta\" data-dictid=\"65f1c4f3d4169277719505249503e0\">phosphatase</span> <strong>(Option A)</strong></li>\n<li>Serum <span class=\"customMeta\" data-dictid=\"015a35fa011692777194a06783f2a8\">osteocalcin</span> <strong>(Option B)</strong></li>\n<li>Protocollagen <span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\">type 1</span> <span class=\"customMeta\" data-dictid=\"f21f213c5d1692777196f648090d87\">propeptide</span> (Carboxyterminal <span class=\"customMeta\" data-dictid=\"f21f213c5d1692777196f648090d87\">Propeptide</span> and Aminoterminal Propeptide) <strong>(Option C)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum:</strong></p>\n<ul>\n<li>Tartrate-Resistant <span class=\"customMeta\" data-dictid=\"1f7d72a93c1692777180c70c94b5a6\">Acid Phosphatase</span> (TRAP)</li>\n<li>Cathepsin-K</li>\n<li>Bone sialoprotein</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Urine:</strong></p>\n<ul>\n<li>Hydroxyproline</li>\n<li>Hydroxylysine</li>\n<li>Free and Total Pyridinoline</li>\n<li>Free and Total Deoxypyridinoline</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Both <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> and urine:</strong></p>\n<ul>\n<li>N-Telopeptide of <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">Collagen</span> Cross-Links <strong>(Option D)</strong></li>\n<li>C-Telopeptide of <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">Collagen</span> Cross-Links</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<figure class=\"caption_element\"><img alt=\"OR003 Bone resorption\" data-author=\"NA\" data-hash=\"6992\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" height=\"500\" src=\"https://image.prepladder.com/notes/g9Fxobd3k0BsO0wxxcwG1743678398.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/qwxumtg2UQSYt5HLuySy1744815393.mp3", "video": ""}, {"text": "During the examination of a patient, the surgeon notices small hard nodules formed over a tendon of the patient. After an X-ray and further evaluation, the surgeon confirms it to be a new bone formation. What is this type of bone called?", "options": [{"label": "A", "text": "Accessory bones", "correct": false}, {"label": "B", "text": "Pneumatic bones", "correct": false}, {"label": "C", "text": "Sesamoid bones", "correct": true}, {"label": "D", "text": "Irregular bones", "correct": false}], "correct_answer": "C. Sesamoid bones", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/nF3Yf9q5p31IcIuhTgvH1737708095.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:556px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types of bones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Long bones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Femur, Humerus, Tibia, Fibula, Metacarpals, Phalanges</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Short bones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Carpals, Tarsals</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Flat bones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Skull bones (frontal, parietal), Ribs, Scapula</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sesamoid bones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Patella, Pisiform</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pneumatic bones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Frontal bone, <span class=\"customMeta\" data-dictid=\"32aabfe5711692777199d68bd57d67\">Sphenoid</span> bone, <span class=\"customMeta\" data-dictid=\"77d6d0146716927771877b0c93c24f\">Ethmoid</span> bone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Accessory bones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sutural bones, os trigonum, os peroneum, os naviculare</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Irregular bones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vertebrae, <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">Pelvic</span> bones, Mandible</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/z9VGsMD26pVsxVg1DSjC1744815910.mp3", "video": ""}, {"text": "A 12-year-old boy presents to the emergency department with fever, localized pain, and swelling over his proximal tibia. Blood tests reveal elevated white blood cell count and inflammatory markers. The X-ray image is shown below. What anatomical characteristic of the metaphysis makes it susceptible to the above condition?", "options": [{"label": "A", "text": "A limited blood supply and poor circulation.", "correct": false}, {"label": "B", "text": "A limited blood supply and poor circulation.", "correct": false}, {"label": "C", "text": "Slow bone turnover and remodeling in the metaphysis.", "correct": false}, {"label": "D", "text": "Small capillary loops that create sites for bacterial trapping.", "correct": true}], "correct_answer": "D. Small capillary loops that create sites for bacterial trapping.", "question_images": ["https://image.prepladder.com/content/KjvknFKcbq6830qXVFFX1737708211.png"], "explanation_images": ["https://image.prepladder.com/content/xBCa5t5Gz4MTM0djtYaP1737708276.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pressure Epiphysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Traction Epiphysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Atavistic Epiphysis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Forms at the<strong> articular</strong> (joint) end of a bone.</li>\n<li>Caused by <strong>constant pressure</strong> and movement due to joint function.</li>\n<li>Examples: Secondary centres at the ends of long bones (humerus, radius, femur, tibia, fibula)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Appears due to the <strong>traction effect </strong>of <strong>tendons pulling</strong> on the bone.</li>\n<li>Ossification often starts around puberty.</li>\n<li>Examples: Tubercles of the <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> and trochanters of the femur.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Represents bones that were separate in lower animals but have become attached in humans.</li>\n<li>Ossifies through a separate centre.</li>\n<li>Example: <span class=\"customMeta\" data-dictid=\"6d706ad0a916927771852098e31258\">Coracoid</span> process of the scapula.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/uk2eHPaHoQVdOMt3XixB1745758017.mp3", "video": ""}, {"text": "A 68-year-old woman is evaluated for chronic back pain and has a history of multiple vertebral fractures. Her DEXA scan shows a significant endosteal bone loss. Which of the following best describes the role of the endosteum in maintaining bone health?", "options": [{"label": "A", "text": "Formation of red blood cells", "correct": false}, {"label": "B", "text": "Regulates bone remodeling", "correct": true}, {"label": "C", "text": "Structural support to the periosteum", "correct": false}, {"label": "D", "text": "Produces synovial fluid", "correct": false}], "correct_answer": "B. Regulates bone remodeling", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/OLL08gVruANUV7Xty2z71737708447.png", "https://image.prepladder.com/content/20ECpB6cefUQEVTlIVXx1737708473.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/VPwqG7UgK9t4HSCdaXwm1744817552.mp3", "video": ""}, {"text": "Which of the following statements is true regarding the structure of compact bone?", "options": [{"label": "A", "text": "It has a high porosity of over 70–80%.", "correct": false}, {"label": "B", "text": "Trabeculae are thin and spread out in a meshwork.", "correct": false}, {"label": "C", "text": "It consists of thick, closely packed trabeculae aligned in the same direction.", "correct": true}, {"label": "D", "text": "It is located primarily in the medullary cavity of short bones.", "correct": false}], "correct_answer": "C. It consists of thick, closely packed trabeculae aligned in the same direction.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/orYs7OAKtGEJR6izy6z81737708711.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:719px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cortical (Compact) Bone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cancellous (Spongy) Bone</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Proportion in Skeleton</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>~80%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>~20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dense and solid, consisting of tightly packed osteons (Haversian systems)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Composed of <span class=\"customMeta\" data-dictid=\"ecfec60ca61692777200dd3d86cd90\">trabeculae</span> arranged in a lattice-like network; Has numerous spaces filled with marrow.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Forms the<strong> outer layer of bones, </strong>particularly in the <span class=\"customMeta\" data-dictid=\"604558eae21692777186613f3915a9\">diaphysis</span> (shaft) of long bones (e.g., humerus, femur)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Found at the ends of long bones (epiphyses), in flat bones (e.g., skull, pelvis), and within the <strong>interior</strong> of other bones</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lamellae Arrangement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Arranged concentrically around <span class=\"customMeta\" data-dictid=\"b0c8b025fd16927771881cceae546d\">Haversian</span> systems</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Parallel to each other</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Porosity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High (&gt; 70–80%)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metabolic Activity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower in comparison</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High (bone cell production, mineral exchange)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Provides strength, protection</li>\n<li>Resists bending and torsion</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Produces red and white blood cells</li>\n<li>Load sharing to the cortex</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone Marrow</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contains <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> storing fat</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Produces red and white corpuscles</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/9COWAZyJgYr2PwbVKxZJ1744870420.mp3", "video": ""}, {"text": "Which of the marked zones is the weakest zone in the growth plate and most prone to fractures?", "options": [{"label": "A", "text": "a", "correct": false}, {"label": "B", "text": "b", "correct": false}, {"label": "C", "text": "c", "correct": true}, {"label": "D", "text": "d", "correct": false}], "correct_answer": "C. c", "question_images": ["https://image.prepladder.com/content/HbHSmy8JTumIH2CzTfL21737708833.png"], "explanation_images": ["https://image.prepladder.com/content/FtXWgQM5F8hikx04YN3J1737708897.png", "https://image.prepladder.com/content/ld7NioST6ztgFIrtorlg1737708940.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:682px\">\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reserve zone </strong><strong>(Option A)</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The reserve zone is situated just below the secondary <span class=\"customMeta\" data-dictid=\"1feb2a0a3016927771847db9449f75\">centre</span> of ossification.</li>\n<li>It contains <strong>undifferentiated or resting <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> cells, </strong>irregularly scattered, with high <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> content.</li>\n<li>Acts as a nutrient storage and <strong>provides <span class=\"customMeta\" data-dictid=\"ae13cdc5c3169277719683e9f6bda5\">precursor</span> cells</strong> for developing <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> in the next zone.</li>\n<li><strong>Damage</strong> to the <strong>reserve zone</strong> can cause <strong>partial</strong> or<strong> complete arrest </strong>o<strong>f bone growth.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Zone of <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">Proliferation</span> </strong><strong>(Option B)</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Located adjacent to the reserve zone, making up about half of the <span class=\"customMeta\" data-dictid=\"4032e2aa0b16927771959902540621\">physis</span> height.</li>\n<li>Chondrocytes begin proliferating, appearing flat but dividing rapidly.</li>\n<li>Cells are organized into columns, laying down the <span class=\"customMeta\" data-dictid=\"ba366417791692777187229d34e597\">extracellular</span> <span class=\"customMeta\" data-dictid=\"14958c535b1692777192abd2a85abf\">matrix</span> of <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> that will later support osteoblasts in ossification.</li>\n<li>Growth in the length of the long bone occurs here.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Zone of Maturation/ Hypertrophic Zone </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cells are organized in columns but enlarge 5 to 10 times compared to the proliferating zone.</li>\n<li>No active growth; chondrocytes begin <span class=\"customMeta\" data-dictid=\"16b76d1d1c1692777200240efcb0e2\">terminal</span> differentiation, leading to <span class=\"customMeta\" data-dictid=\"2f3a62230316927771846649e8b780\">cell death</span> and triggering <span class=\"customMeta\" data-dictid=\"72c06d2cc71692777183b1cbaf5bae\">blood vessel</span> invasion for bone formation.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"ba366417791692777187229d34e597\">extracellular</span> matrix, rich in collagens and proteoglycans, diminishes, making this zone the<strong> weakest </strong>and<strong> <span class=\"customMeta\" data-dictid=\"607476ab371692777196d0cb2f13bc\">prone</span> to fractures</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Zone of <span class=\"customMeta\" data-dictid=\"e141602f62169277719672727e4f53\">Provisional</span> <span class=\"customMeta\" data-dictid=\"a1ee14c673169277718351bfe6afd4\">Calcification</span> </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Blood vessels invade the dismantled scaffold, allowing <span class=\"customMeta\" data-dictid=\"3407065fc9169277719436a1ce6d8f\">osteogenic</span> progenitor cells to deposit trabecular bone.</li>\n<li>Remodeling involves variations in <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> and <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> levels, influencing the <span class=\"customMeta\" data-dictid=\"d52b8551541692777187be85e4bb2f\">equilibrium</span> between <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> <span class=\"customMeta\" data-dictid=\"d395f610461692777185cbe8b8806d\">degradation</span> and bone formation.</li>\n<li>Matrix degradation, mineralization, and the influx of new cells regulate the transition from <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> to bone.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/WhlJD0Bh6rG2Xvkis1yx1744870506.mp3", "video": ""}, {"text": "Match the following 1) Ostecytes a) Connects Haversian canals 2) Volkmann’s canals b) Contains vasculature, nerves, and lymphatics 3) Canaliculi c) Formed from osteoblasts trapped in lacunae 4) Haversian canal d) Facilitates communication between osteocytes", "options": [{"label": "A", "text": "1-d, 2-a, 3-d, 4-c", "correct": false}, {"label": "B", "text": "1-d, 2-c, 3-b, 4-a", "correct": false}, {"label": "C", "text": "1-c, 2-a, 3-d, 4-b", "correct": true}, {"label": "D", "text": "1-b, 2-a, 3-d, 4-c", "correct": false}], "correct_answer": "C. 1-c, 2-a, 3-d, 4-b", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/SDMPBXHBDJLox0F6NMJn1737709096.png", "https://image.prepladder.com/content/HrbKJPWwnk3jjQw1tbiX1737709134.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:499px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1) Osteocytes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>c) Formed from osteoblasts trapped in lacunae</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2) Volkmann’s canals</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>a) Connects <span class=\"customMeta\" data-dictid=\"b0c8b025fd16927771881cceae546d\">Haversian</span> canals</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3) Canaliculi</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>d) Facilitate communication between osteocytes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4) <span class=\"customMeta\" data-dictid=\"b0c8b025fd16927771881cceae546d\">Haversian</span> canal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>b) Contains vasculature, nerves, and lymphatics</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/MIhvVP9ynZH7TOoUu4hf1744870642.mp3", "video": ""}, {"text": "Arrange the following steps of the bone remodelling cycle in the right sequence. Quiescent period Osteoblasts prompt osteoclasts to excavate a cavity on the bone surface Osteoclast apoptosis and phagocytosis Osteoblasts cover the cavity and lay down osteoid", "options": [{"label": "A", "text": "1→2→3→4", "correct": false}, {"label": "B", "text": "2→3→1→4", "correct": true}, {"label": "C", "text": "2→1→3→4", "correct": false}, {"label": "D", "text": "3→1→2→4", "correct": false}], "correct_answer": "B. 2→3→1→4", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/n67rmHGXOY7CrDjHIvUF1737709218.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/YYYcYaVnEEOaQQNdaHq11744871892.mp3", "video": ""}, {"text": "A 25-year-old male presents to the emergency department after falling off a bike and landing on his arm. On examination, the following features are noted: Tenderness Deformity Bruising Loss of function Abnormal movement Which of the following sets of features are considered classical signs of a fracture?", "options": [{"label": "A", "text": "1, 3, and 4", "correct": false}, {"label": "B", "text": "2, 3, and 5", "correct": false}, {"label": "C", "text": "1, 2, and 5", "correct": true}, {"label": "D", "text": "3, 4, and 5", "correct": false}], "correct_answer": "C. 1, 2, and 5", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tenderness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Localized pain at the site of the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> when pressure is applied. Often the first sign noted in trauma cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Crepitus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"3643a86e981692777188a04b7e2b5a\">grating</span> or crackling sensation felt or heard when the broken bone ends move against each other.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Abnormal Mobility</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Movement of the bone at a point where there is no natural joint, indicating a loss of <span class=\"customMeta\" data-dictid=\"17e718612e1692777185f79acb759b\">continuity</span> in the bone.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Deformity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Visible misalignment or <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> positioning of the bone due to <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of bone fragments.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Loss of Transmitted Movements</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absence of force transmission along the bone, such as in long bones, where tapping the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> end does not transmit vibrations to the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> end.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/bgzWLViJoxwdVpxSsClx1744872036.mp3", "video": ""}, {"text": "A 35-year-old male presents following a high-speed motor vehicle accident. He complains of severe pain and swelling in both lower limbs. Upon physical examination, the affected areas had significant bruising, deformity, and tenderness. An X-ray is performed. What type of fracture is most likely based on the X-ray findings?", "options": [{"label": "A", "text": "Oblique fracture", "correct": false}, {"label": "B", "text": "Transverse fracture", "correct": false}, {"label": "C", "text": "Comminuted fracture", "correct": true}, {"label": "D", "text": "Spiral fracture", "correct": false}], "correct_answer": "C. Comminuted fracture", "question_images": ["https://image.prepladder.com/content/HXsV91igZqlqQ5B22TN41737709438.png"], "explanation_images": ["https://image.prepladder.com/content/BvirMWkPaeA0CMBwMCmS1737709570.png", "https://image.prepladder.com/content/scoLXpP9aiBpiVTARp121737709617.png", "https://image.prepladder.com/content/RKqQfGGGwc4yVMa69kfI1737709654.png", "https://image.prepladder.com/content/yuCeG0FIefzs8ePaTqrG1737709690.png", "https://image.prepladder.com/content/alSX7zNx0Ag2glygc3iU1737709493.png", "https://image.prepladder.com/notes/4QeSQbmrcCmmLjnBERUG1743678688.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:742px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Fracture Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Additional Information</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transverse <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The bone is broken perpendicular to its length.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Jones J, Niknejad M, Al Kabbani A, et al. \" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/transverse-fracture\" data-tags=\"\" height=\"631\" src=\"https://image.prepladder.com/content/BvirMWkPaeA0CMBwMCmS1737709570.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Very Good</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal complications (if properly treated).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common in direct impact injuries; <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> time is typically faster due to the clean, straight break.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oblique Fracture</strong><br/>\n<strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bone is broken at an <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> angle (diagonal break).</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Jones J,\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/oblique-tibial-fracture\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/scoLXpP9aiBpiVTARp121737709617.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Best</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal complications if treated early.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Frequently caused by a sharp angled force; more unstable than <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> fractures and may require internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> (e.g., plates or screws).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Spiral Fracture</strong><strong> (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bone is twisted apart by a rotational force.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"RSJThompson\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Spiral_fracture\" data-tags=\"\" height=\"498\" src=\"https://image.prepladder.com/content/RKqQfGGGwc4yVMa69kfI1737709654.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Good</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rotatory <span class=\"customMeta\" data-dictid=\"e9c1a7fec316927771915c5460d9a7\">Malunion</span> (misalignment of <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> bones).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often seen in sports injuries or twisting accidents; requires careful <span class=\"customMeta\" data-dictid=\"3c0c325f4216927771819e5d0eb581\">alignment</span> during treatment to avoid <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> or improper healing.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Segmental Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bone is broken into two or more places, creating distinct segments.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Gadegone, Wasudeo &amp; Gadegone, Piyush &amp; Lokhande, Vijayanand. \" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/A-Segmental-fracture-l-tibia-B-post-op-x-ray-with-suprapatellar-nail-and-C-six_fig4_376766896\" data-tags=\"\" height=\"174\" src=\"https://image.prepladder.com/content/yuCeG0FIefzs8ePaTqrG1737709690.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Avascular Necrosis, Non-union (failure of healing).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>This <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> is more complex due to the separated bone segments, which may interrupt blood supply, leading to <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> or delayed union.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Comminuted Fracture</strong><strong> (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bone is shattered into multiple fragments.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ghorbanhoseini, Mohammad &amp; Riedel, Matthew &amp; Gonzalez, Tyler &amp; Hafezi, Poopak &amp; Kwon, John.\" data-hash=\"\" data-license=\"CC BY NC 4.0\" data-source=\"https://www.researchgate.net/figure/ray-2-comminuted-displaced-fracture_fig2_318492019\" data-tags=\"\" height=\"776\" src=\"https://image.prepladder.com/content/alSX7zNx0Ag2glygc3iU1737709493.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-union, Infection, Soft tissue damage.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually caused by high-energy trauma like car accidents or falls from a height; often requires <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention, including external <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> or bone grafting.</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/jEKOvO8FXLMTuMarT8YE1744873371.mp3", "video": ""}, {"text": "Which of the following age groups is a greenstick fracture most commonly observed?", "options": [{"label": "A", "text": "Infants before epiphyseal closure", "correct": false}, {"label": "B", "text": "Children before epiphyseal closure", "correct": true}, {"label": "C", "text": "Children after epiphyseal closure", "correct": false}, {"label": "D", "text": "Adolescents after epiphyseal closure", "correct": false}], "correct_answer": "B. Children before epiphyseal closure", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/VVVqJFuONp9376eUgAaP1737710073.png", "https://image.prepladder.com/content/SDnMrqOdQtj4mpveKZa21737710091.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A greenstick <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> is an incomplete <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> commonly seen in children, where one <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> of the bone is broken while the other <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> remains intact, resembling the bending and partial breaking of a young, flexible bamboo.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"3873\" src=\"https://image.prepladder.com/content/VVVqJFuONp9376eUgAaP1737710073.png\" width=\"3872\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most Common <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> in Children: Occurs before <span class=\"customMeta\" data-dictid=\"dc486020a916927771874098596bbc\">epiphyseal</span> closure, predominantly in children aged 4 to 10 years.</li>\n<li>Most Affected Bone: Typically involves the <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> bones (radius and ulna).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Patients often present with pain, tenderness, and <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> over the affected area.</li>\n<li>There may be a limitation in the range of motion.</li>\n<li>The mechanism of injury often involves a fall or a direct blow to the arm.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>X-ray:</strong> Shows a small opening or a line at one <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> with the other <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> remaining intact.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Hellerhoff \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Greenstick_fracture\" data-tags=\"\" height=\"1772\" src=\"https://image.prepladder.com/content/SDnMrqOdQtj4mpveKZa21737710091.png\" width=\"934\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Radiographic appearance resembles a <strong>bending of the bone rather than a complete break.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Analogy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The term \"greenstick\" is derived from the <span class=\"customMeta\" data-dictid=\"177815407516927771811aae3c8efe\">analogy</span> of young bamboo; when young bamboo is broken, only one <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> breaks, similar to this type of fracture, whereas <span class=\"customMeta\" data-dictid=\"0472620c171692777192c655af9c57\">mature</span> bamboo may break both cortices.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Conservative Management: </strong>Treatment typically involves <span class=\"customMeta\" data-dictid=\"3024d9916e16927771896f5b7159b6\">immobilization</span> with a <span class=\"customMeta\" data-dictid=\"6c22f2390016927771955c0c04b851\">Plaster</span> of Paris (POP) cast.</li>\n<li>In cases where the intact <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> is also fractured, additional <span class=\"customMeta\" data-dictid=\"8c6ba9ffab1692777183324e3a5ed3\">casting</span> may be required to ensure complete <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> and prevent complications such as delayed union or non-union.</li>\n<li><strong>Surgical Intervention: </strong>Generally not performed before <span class=\"customMeta\" data-dictid=\"dc486020a916927771874098596bbc\">epiphyseal</span> closure, as conservative management is sufficient for healing.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Greenstick fractures generally heal well with appropriate treatment, and complete recovery is expected within a few weeks, depending on the child's age and bone growth potential.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/mchfZprK9C57ftTBI3261744873928.mp3", "video": ""}, {"text": "A newly joined military recruit presents with continuous pain in the right lower limb after the morning drill. On physical examination, there is localized tenderness over the midshaft of the second metatarsal. X-ray imaging is provided. What is the most appropriate next step in the management of this patient?", "options": [{"label": "A", "text": "Rest and activity modification", "correct": true}, {"label": "B", "text": "Surgical fixation of the metatarsal", "correct": false}, {"label": "C", "text": "Application of a leg cast", "correct": false}, {"label": "D", "text": "Immediate return to physical activity", "correct": false}], "correct_answer": "A. Rest and activity modification", "question_images": ["https://image.prepladder.com/content/9POt0HilckItkxy6iXVT1737710543.png"], "explanation_images": ["https://image.prepladder.com/content/LpIfWHXReSzEOhSDwysO1737710426.png", "https://image.prepladder.com/content/HB7N5H449ouT9t6mJIJr1737710591.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hairline fractures, also known as march or stress fractures, are small cracks in the bone that develop due to repetitive stress or overuse, particularly when the bone is subjected to excessive weight or pressure.</p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Yavuz, Umut &amp; Sökücü, Sami &amp; Demir, Bilal &amp; Akpinar, Evren &amp; Lapçin, Osman &amp; Atici, Yunus &amp; Kabukcuoglu, Yavuz.\" data-hash=\"\" data-license=\"CC BY\" data-source=\"https://www.researchgate.net/figure/Anteroposterior-and-lateral-X-rays-showing-stress-fracture-in-proximal-metaphysis-of-left_fig2_259560379\" data-tags=\"\" height=\"1100\" src=\"https://image.prepladder.com/content/LpIfWHXReSzEOhSDwysO1737710426.png\" width=\"1232\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Metatarsal Bones: Most commonly affect the 2nd metatarsal.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Hanneke Weel\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/X-ray-of-MT-V-stress-fracture-a-AP-view-b-Oblique-view-Stress-fracture-of-the-MT-V_fig3_281486740\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/HB7N5H449ouT9t6mJIJr1737710591.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>March Fracture: Named for its <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> among military personnel during long marches or drills.</li>\n<li>Stress fractures can occur in any bone but are most frequently seen in weight-bearing bones.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Patients typically present with complaints of pain in the foot, especially during activity or weight-bearing activities.</li>\n<li>Swelling may or may not be present, making it an <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> fracture.</li>\n<li>There is often <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> at the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> site, and pain usually worsens with activity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Digital X-ray: <span class=\"customMeta\" data-dictid=\"6fda63a90c1692777202563d33a81b\">X-rays</span> may show subtle changes or a thin line in the bone but may not always be visible in the early stages.</li>\n<li>MRI or bone scans can be used if the diagnosis remains unclear, as they are more sensitive in detecting stress fractures.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rest: <span class=\"customMeta\" data-dictid=\"63b27629261692777182cc4d582eca\">Bed rest</span> for 2-3 weeks is generally recommended to allow the bone to heal.</li>\n<li>Medication: NSAIDs can be prescribed for pain relief.</li>\n<li>Orthotic Support: Protective footwear or <span class=\"customMeta\" data-dictid=\"fb1dda661716927771940236cca335\">orthotics</span> may be suggested to reduce stress on the affected bone.</li>\n<li>Activity Modification: Gradual return to activity is important to prevent recurrence.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/nTJbqRbqFIav8KWi0uCL1744874052.mp3", "video": ""}, {"text": "A 10-year-old schoolboy was playing on the monkey bars during recess when he suddenly slipped and fell onto his outstretched hand. He immediately felt intense pain in his wrist. On examination, there is significant swelling and tenderness over the wrist. An X-ray of the wrist reveals specific findings indicative of a fracture. Based on the history, clinical features, and X-ray findings, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Avulsion fracture", "correct": false}, {"label": "B", "text": "Impacted fracture", "correct": false}, {"label": "C", "text": "Torus fracture", "correct": true}, {"label": "D", "text": "Greenstick fracture", "correct": false}], "correct_answer": "C. Torus fracture", "question_images": ["https://image.prepladder.com/content/XzD6ev7rm5RtI2YCAWlk1737711081.png"], "explanation_images": ["https://image.prepladder.com/content/bjWIXuhu8beXWL4Ogsdo1737710859.png", "https://image.prepladder.com/content/7kHygr5NbvrAvq4nUBPv1737710877.png", "https://image.prepladder.com/content/dQVnE0zOA2YHrO27aqxX1737711029.png", "https://image.prepladder.com/content/cTtuCXRUr4uVBXFBY3bC1737710918.png", "https://image.prepladder.com/content/p3T3lsjpSs7tujLZiIwh1737710967.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:669px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Torus fractures, also known as buckle fractures, occur when the <span class=\"customMeta\" data-dictid=\"ae97d0e84f169277719537f321c02b\">periosteum</span> (the outer layer of the bone) buckles or compresses, typically due to <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> <span class=\"customMeta\" data-dictid=\"00a5dcc74b16927771913b344e36a3\">loading</span> forces. This type of <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> is incomplete.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"3873\" src=\"https://image.prepladder.com/content/bjWIXuhu8beXWL4Ogsdo1737710859.png\" width=\"3872\"/></p>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most frequently affects long bones, especially the <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> (particularly the lower end near the metaphysis, where bones are more <span class=\"customMeta\" data-dictid=\"b2a22f1dff169277719977c0a8ee4a\">spongy</span> and <span class=\"customMeta\" data-dictid=\"55691242bb1692777199360f64cb67\">susceptible</span> to compression).</li>\n<li>The <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> is another common site, particularly in falls involving outstretched hands (FOOSH injuries).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>There is minimal <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> and pain over the affected site.</li>\n<li>Unlike complete fractures, there is no visible bone displacement.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radiographs show a subtle <span class=\"customMeta\" data-dictid=\"2cdd3187321692777183fb22d77cfb\">buckling</span> of the cortex, but there is no break in bone continuity. The <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> may require careful interpretation to <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> from complete fractures.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Immobilization with a <span class=\"customMeta\" data-dictid=\"6c22f2390016927771955c0c04b851\">plaster</span> of Paris (POP) slab for 4–5 weeks is usually sufficient.</li>\n<li>Surgery is not needed, as these fractures typically heal well with conservative treatment. Follow-up may include monitoring for any signs of <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> or complications.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:666px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An <span class=\"customMeta\" data-dictid=\"954dd74f031692777182664659765f\">avulsion</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> occurs when a <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> or <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> pulls off a piece of bone from its <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> site due to sudden, forceful <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> or <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> of the attached muscle.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"3873\" src=\"https://image.prepladder.com/content/7kHygr5NbvrAvq4nUBPv1737710877.png\" width=\"3872\"/></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\" James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Avulsion_fracture\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/dQVnE0zOA2YHrO27aqxX1737711029.png\" width=\"2221\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p>Avulsion <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of ACL</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tibial Tuberosity: The most common site, often associated with <span class=\"customMeta\" data-dictid=\"bc00bd5d23169277719496684d6b6c\">Osgood-Schlatter disease</span> or sports-related injuries.</li>\n<li>Tendo Achilles (Achilles tendon): <span class=\"customMeta\" data-dictid=\"954dd74f031692777182664659765f\">Avulsion</span> can occur due to excessive tension or a sudden contraction, especially during sports like running or jumping.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sudden onset of pain at the site of <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> insertion.</li>\n<li>Swelling and limited movement are often observed.</li>\n<li>The patellar <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> is frequently involved, and the small bone fragment pulled by the <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> may fail to reunite properly, leading to non-union.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diagnosis is often made based on clinical evaluation and imaging.</li>\n<li>X-rays may show a small bony fragment at the site of <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> insertion, confirming the avulsion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Small fractures are typically treated with rest and immobilization.</li>\n<li>Larger fragments or cases with non-union often require <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> using mini-screws, followed by <span class=\"customMeta\" data-dictid=\"3024d9916e16927771896f5b7159b6\">immobilization</span> to allow for healing.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:670px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An <span class=\"customMeta\" data-dictid=\"ab375457da16927771891fcf9431da\">impacted</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> occurs when the broken ends of the bone are driven into each other, resulting in the telescoping of the fragments. This type of <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> may be difficult to detect on <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> due to minimal displacement.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"3873\" src=\"https://image.prepladder.com/content/cTtuCXRUr4uVBXFBY3bC1737710918.png\" width=\"3872\"/></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Hellerhoff\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Transzervikale_Femurfraktur_links_56M_-_CR_ap_-_001.jpg\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/p3T3lsjpSs7tujLZiIwh1737710967.png\" width=\"2962\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Neck of the Femur: </strong>The most commonly affected site, often seen in older adults following a fall.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> fragment (head of the femur) is driven into the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> fragment (neck), creating the characteristic <span class=\"customMeta\" data-dictid=\"ab375457da16927771891fcf9431da\">impacted</span> fracture.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Patients often experience pain in the <span class=\"customMeta\" data-dictid=\"a48fa02dfe1692777188de798e404f\">groin</span> or hip area and have difficulty <span class=\"customMeta\" data-dictid=\"2bb6ddacfd169277718230a816b21f\">bearing</span> weight.</li>\n<li>There may be a limited <span class=\"customMeta\" data-dictid=\"069cba94231692777197b41e753795\">range of motion</span> in the affected joint.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Due to the telescoping of bone fragments, <span class=\"customMeta\" data-dictid=\"6fda63a90c1692777202563d33a81b\">X-rays</span> may show minimal <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> lines, requiring a careful radiographic assessment to ensure an accurate diagnosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Disimpaction of the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> is crucial and is typically done through gentle <span class=\"customMeta\" data-dictid=\"fb84ef68cf1692777191f6e12eeebe\">manipulation</span> to separate the fragments.</li>\n<li>If the blood supply to the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head is intact, the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> can be internally fixed using screws or a plate to stabilise the bone and promote healing.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/lpoteBRX0A5at64jJKJn1744874344.mp3", "video": ""}, {"text": "A 65-year-old man arrives at the clinic with acute back pain after lifting heavy boxes. He has a history of osteoporosis and presents with tenderness in the lower thoracic region. A lateral x-ray of the thoracic spine is taken and is shown below. What is the most appropriate initial management for this patient?", "options": [{"label": "A", "text": "Surgical intervention", "correct": false}, {"label": "B", "text": "Prolonged bed rest", "correct": false}, {"label": "C", "text": "Immediate physical therapy", "correct": false}, {"label": "D", "text": "Conservative treatment with analgesics and a brace", "correct": true}], "correct_answer": "D. Conservative treatment with analgesics and a brace", "question_images": ["https://image.prepladder.com/content/hloIgmvRB6Dpy9CKSlPK1737711192.png"], "explanation_images": ["https://image.prepladder.com/content/vUINE0cY05L0V4o0ZFZS1737711271.png", "https://image.prepladder.com/content/HVIPonfbZSVN4f1Qe0841737711372.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wedge-shaped Deformity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Collapse of the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> portion of the vertebral body results in a wedge-shaped deformity, characteristic of this <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> type.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"3873\" src=\"https://image.prepladder.com/content/vUINE0cY05L0V4o0ZFZS1737711271.png\" width=\"3872\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Most Common Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thoracolumbar <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> (i.e., segment from T12 to L2)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Osteoporosis (M/c)</li>\n<li>Trauma</li>\n<li>Infection</li>\n<li>Neoplasm</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Occurs secondary to an <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> or compressive load with resultant biomechanical failure of the vertebral body resulting in a fracture.</li>\n<li><strong>Anterior Column Involvement: </strong>Fracture compromises the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> column of the spine, affecting the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> half of the vertebral body (VB) and the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"7ba18aa5e616927771918a45051a40\">longitudinal</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (ALL).</li>\n<li><strong>Posterior Column: </strong>Usually intact so that the injury is stable.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pain</li>\n<li>Neurologic deficits tend to be infrequent</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>A-P and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> radiograph:</strong> To exclude <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of the vertebral body <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> (unstable fracture).</li>\n<li><strong>If doubt about <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> column injury:</strong> CT or <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> done.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Sifuentes Giraldo, W. &amp; Rivera, José &amp; Díaz, Mónica.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Lateral-X-ray-of-the-thoracic-spine-showing-apparent-anterior-wedge-compression-fractures_fig1_260444673\" data-tags=\"\" height=\"3932\" src=\"https://image.prepladder.com/content/HVIPonfbZSVN4f1Qe0841737711372.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Short period of bed rest. <strong>(Option B) </strong></li>\n<li>No reduction is required. <strong>(Option A) </strong></li>\n<li>Neck immobilized initially using skull <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> or <span class=\"customMeta\" data-dictid=\"5e2a7b127c1692777198f4895cc7c0\">sling</span> traction.</li>\n<li>Once pain and muscle spasms subside, the neck is then supported using a <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> collar, PoP cast, or brace.</li>\n<li>Neck exercises are initiated after 8-12 weeks to restore function. <strong>(Option C) </strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/T9Qi3C2bUPcfIIKPC2d01744874474.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 26 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 17</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Bone And Imaging-Bone And Imaging-Ii - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 17</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 17 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 12-year-old boy presents with hip pain and limping. He has a history of obesity and is at risk for slipped capital femoral epiphysis. What radiographic view would be most appropriate to assess his condition?", "options": [{"label": "A", "text": "Dunn’s View", "correct": false}, {"label": "B", "text": "Frog Leg Lateral View", "correct": true}, {"label": "C", "text": "Danelius-Miller’s View", "correct": false}, {"label": "D", "text": "Clement’s Nakayama View", "correct": false}], "correct_answer": "B. Frog Leg Lateral View", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/1pD1CBb0np91ia4tGtqm1737735592.png", "https://image.prepladder.com/content/cqZK3LAOwaHsEVlAw3NB1737735859.png", "https://image.prepladder.com/content/3PY3KhqgL2H2S0ZCctR51737735905.png", "https://image.prepladder.com/content/ZdBvoEluFDAOvE3xmRmF1737735941.png", "https://image.prepladder.com/content/4NOasiodGf3rcCaeIeOZ1737735986.png", "https://image.prepladder.com/content/aYhz88d7CIjeIspNGI0w1737736026.png", "https://image.prepladder.com/content/yNdASfgetZnjm7bbs8EX1737736082.png", "https://image.prepladder.com/content/9yHxdHZ6DAjooTPZYLDU1737736109.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/QbmPQ2NqoThZYJgudt2V1744958646.mp3", "video": ""}, {"text": "A 45-year-old woman with a history of alcohol use disorder presents with hip pain. An MRI of the hip reveals a smooth, linear geographic signal abnormality that is concave to the articular surface. There are central fat signals and both low- and high-signal demarcation lines. What condition is most likely indicated by the MRI findings in this patient?", "options": [{"label": "A", "text": "Osteoarthritis", "correct": false}, {"label": "B", "text": "Avascular necrosis", "correct": true}, {"label": "C", "text": "Osteomyelitis", "correct": false}, {"label": "D", "text": "Rheumatoid arthritis", "correct": false}], "correct_answer": "B. Avascular necrosis", "question_images": ["https://image.prepladder.com/content/dTivk4Oh9NkeAwznXTly1737731249.png"], "explanation_images": ["https://image.prepladder.com/content/P6xBzmey3czGQz3IDzvw1737731297.png", "https://image.prepladder.com/content/catVNB0q3FbHhznsn9tW1737731358.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disadvantages</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Non-invasive, no radiation</li>\n<li>Clear, detailed soft tissue images</li>\n<li>Captures images from multiple angles</li>\n<li>Helps detect cancer spread and guides treatment</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Expensive</li>\n<li><strong>Metal implants </strong>can be affected by the <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> magnet</li>\n<li>Gantry is narrower than in CT</li>\n<li>Claustrophobic patients may feel discomfort in the enclosed machine</li>\n<li>Patient must remain still, dynamic test not possible</li>\n<li>Noisy</li>\n<li>Gadolinium contrast is not recommended for use in pregnant women.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:530px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #ffffff; border-left:1px solid #ffffff; border-right:1px solid #ffffff; border-top:1px solid #ffffff; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Contraindications:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #ffffff; border-left:1px solid #ffffff; border-right:1px solid #ffffff; border-top:1px solid #ffffff; vertical-align:top\">\n<ul>\n<li>Cardiac Implantable Electronic Devices (CIED)</li>\n<li>Cerebral <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">Aneurysm</span> Clips</li>\n<li>Implantable <span class=\"customMeta\" data-dictid=\"a91d51051316927771931aa3fc3d35\">Neurostimulation</span> Systems</li>\n<li><strong>Catheters with <span class=\"customMeta\" data-dictid=\"84433cae211692777192a484f539bc\">Metallic</span> Components (e.g., Swan-Ganz Catheter)</strong></li>\n<li>Magnetic <span class=\"customMeta\" data-dictid=\"02cf7655661692777185e2bf5c3254\">Dental</span> Implants</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #ffffff; border-left:1px solid #ffffff; border-right:1px solid #ffffff; border-top:1px solid #ffffff; vertical-align:top\">\n<ul>\n<li>Metallic Fragments (Bullets, Pellets, Shrapnel)</li>\n<li>Drug <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">Infusion</span> Pumps</li>\n<li>Cochlear Implants</li>\n<li>Tissue Expander</li>\n<li>Artificial Limbs</li>\n<li>Hearing Aids</li>\n<li>Piercing</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/FD5C0JBguvXsYNpho8xP1744888792.mp3", "video": ""}, {"text": "A 45-year-old woman presents with knee pain and a suspected patellar fracture after a fall. The physician orders imaging to evaluate the fracture. Which of the following radiographic views would not be appropriate for assessing a patellar fracture?", "options": [{"label": "A", "text": "Merchant View", "correct": false}, {"label": "B", "text": "Sunrise View", "correct": false}, {"label": "C", "text": "AP Knee View", "correct": true}, {"label": "D", "text": "Horizontal Beam Lateral View", "correct": false}], "correct_answer": "C. AP Knee View", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/PPR7W0tvZL8ldeiRVTIA1737737158.png", "https://image.prepladder.com/content/TVPDdBFyQePOfGBcr51b1737737202.png", "https://image.prepladder.com/content/sVd5uh8f0cGgBg7xeiaY1737737256.png", "https://image.prepladder.com/content/V9P1kqMVvC5jH4WqHIiC1737737295.png", "https://image.prepladder.com/content/wlKZ1gQteVsyhdDGlyjw1737737360.png", "https://image.prepladder.com/content/58AHDnEtVjjtNuCa4Ikr1737737403.png", "https://image.prepladder.com/content/tWP9vcwIvYCoFzvJrZWR1737737422.png", "https://image.prepladder.com/content/oU43RKxfrfBxChV3tCAa1737737464.png", "https://image.prepladder.com/content/QN9dvNWETLopvpBGo9un1737737600.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/vxR6W8jQNBq5QPxKSLXF1744958736.mp3", "video": ""}, {"text": "Match the following: View Indication 1. Scaphoid View A. Thumb trapeziometacarpal arthritis. 2. Carpal Tunnel View B. Scaphoid fracture. 3. Clenched Fist View C. Fractures of the hook of the hamate 4. Brewerton’s View D. Widening of the scapholunate interval. 5. Robert’s View E. Collateral ligament avulsion fracture.", "options": [{"label": "A", "text": "1D,2A,3E,4C,5B", "correct": false}, {"label": "B", "text": "1B,2C,3D,4E,5A", "correct": true}, {"label": "C", "text": "1A,2D,3E,4B,5C", "correct": false}, {"label": "D", "text": "1B,2E,3A,4C,5D", "correct": false}], "correct_answer": "B. 1B,2C,3D,4E,5A", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/b7PiJB6Sv5cZFtaOM1KB1737734801.png", "https://image.prepladder.com/content/CM50XJ2Zwe9GUQHdnzXC1737734847.png", "https://image.prepladder.com/content/VmnVSGTCFpgOAhjItlCY1737734892.png", "https://image.prepladder.com/content/nTQfRwg20iUUv2VY0h8W1737734933.png", "https://image.prepladder.com/content/MDEZ8OFJFnikObfvOrtv1737734971.png", "https://image.prepladder.com/content/NcUCQbk7WnYzAQqiug0B1737735027.png", "https://image.prepladder.com/content/NxfRBkYVa5QmXeWOHXHe1737735065.png", "https://image.prepladder.com/content/xSlOwyZC2dLe76UUHvHh1737735139.png", "https://image.prepladder.com/content/E9YIogbr06RBnOHOuGxv1737735227.png", "https://image.prepladder.com/content/qbklaXiiY05O5AQBcYiG1737735299.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/n0XsDrMXUnk6rpOlqmCR1744958574.mp3", "video": ""}, {"text": "A 30-year-old female presents with shoulder pain after a sports injury. The physician suspects an anterior glenohumeral dislocation and orders imaging. Which imaging view is best for assessing Hill-Sachs defects?", "options": [{"label": "A", "text": "Zanca’s View", "correct": false}, {"label": "B", "text": "Coyle’s View", "correct": false}, {"label": "C", "text": "Scapular Y View", "correct": false}, {"label": "D", "text": "Stryker’s Notch View", "correct": true}], "correct_answer": "D. Stryker’s Notch View", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/uMJxYHSH70s89W75GVn31737734230.png", "https://image.prepladder.com/content/CDFSzqT6GjNqdyflHmac1737734343.png", "https://image.prepladder.com/content/94bT2g62d5W8EdmThdmR1737734423.png", "https://image.prepladder.com/content/5jtucwl5CSM0B8DVGoYZ1737734523.png", "https://image.prepladder.com/content/uT5b9wMXRZkKdPn9O80L1737734553.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/c3n10T347P3pgO3M4DXr1744958376.mp3", "video": ""}, {"text": "A 35-year-old female presents with severe shoulder pain after a fall. She is unable to abduct her arm and has a suspected posterior shoulder dislocation. The physicin orders imaging to confirm the diagnosis. Which imaging view is most appropriate for diagnosing her condition?", "options": [{"label": "A", "text": "Axial View", "correct": false}, {"label": "B", "text": "Velpeau View", "correct": true}, {"label": "C", "text": "Grashey’s View", "correct": false}, {"label": "D", "text": "Serendipity View", "correct": false}], "correct_answer": "B. Velpeau View", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/j8uPFBXXFv6A1tRIdzUC1737733793.png", "https://image.prepladder.com/content/tBSoI7dJivzBNPrC9Bku1737734005.png", "https://image.prepladder.com/content/qZwi6fhD1KANT5NH6saR1737733820.png", "https://image.prepladder.com/content/ujyvLFJCDT1Rc3DcGR1W1737733953.png", "https://image.prepladder.com/content/z7HoCeG3cZ9h4yNPQMzk1737733901.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ibgJhOU1U6kJabRDToIJ1744957875.mp3", "video": ""}, {"text": "A 28-year-old male athlete presents with severe pain and swelling in his right shoulder after falling during a basketball game. The physician suspects an acromioclavicular joint injury and orders an X-ray. Which imaging view is best for evaluating the acromioclavicular joint?", "options": [{"label": "A", "text": "Cephalic Tilt View", "correct": false}, {"label": "B", "text": "Serendipity View", "correct": false}, {"label": "C", "text": "Westpoint View", "correct": false}, {"label": "D", "text": "Zanca’s View", "correct": true}], "correct_answer": "D. Zanca’s View", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/WIZIJP2Yaa8jLjSO7aMh1737731974.png", "https://image.prepladder.com/content/UdiD0diXCClQfVDH3z2Q1737732249.png", "https://image.prepladder.com/content/xCuS1r7xeOQ70QzGCOIW1737731998.png", "https://image.prepladder.com/content/yfcgdKOPKSbqqnac2Mtg1737732299.png", "https://image.prepladder.com/content/VbzrNECcfVA5Wu0fQbF31737732094.png", "https://image.prepladder.com/content/nVeuSuDhemNf5qLYeX4v1737732386.png", "https://image.prepladder.com/content/5dakXpBr3o92byPwYaFx1737732117.png", "https://image.prepladder.com/content/svbdeJFoagQHQKBChKSC1737732429.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:452px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>X-ray view</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Visualization </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cephalic tilt view</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clavicle</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Serendipity view</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sternoclavicular joints</li>\n<li>Medial 1/3 of the clavicles for fractures or dislocation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Zanca’s view</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acromioclavicular joint</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Westpoint view</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anterior <span class=\"customMeta\" data-dictid=\"7649bd0f191692777188dcdf91af69\">glenoid</span> abnormality</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/6chw8Qygv04DMmZLv3Y21744957375.mp3", "video": ""}, {"text": "A 33-year-old pregnant woman with a history of breast cancer is suspected to have bone metastases. The oncologist opts for an MRI scan to confirm the diagnosis. What is the primary reason MRI is chosen over other imaging modalities in this pregnant patient?", "options": [{"label": "A", "text": "MRI provides a more detailed assessment of bone metastases.", "correct": false}, {"label": "B", "text": "MRI does not use ionizing radiation, making it safer during pregnancy.", "correct": true}, {"label": "C", "text": "MRI is faster than CT in staging bone metastases.", "correct": false}, {"label": "D", "text": "MRI provides more specific metabolic information than nuclear scans.", "correct": false}], "correct_answer": "B. MRI does not use ionizing radiation, making it safer during pregnancy.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/1rMRE6NfEpu7DWBWiloT1744957223.mp3", "video": ""}, {"text": "A 40-year-old male presents with chronic osteomyelitis of the Femur after an open fracture. He experiences persistent drainage from a sinus tract. MRI is given below. What is the significance of the marked sign in this patient?", "options": [{"label": "A", "text": "Indicates the presence of cloacae", "correct": false}, {"label": "B", "text": "Represents the reactive hypervascular granulation tissue surrounding a necrotic cavity", "correct": true}, {"label": "C", "text": "Confirms the presence of a tumor-like lesion", "correct": false}, {"label": "D", "text": "Suggests acute inflammatory changes", "correct": false}], "correct_answer": "B. Represents the reactive hypervascular granulation tissue surrounding a necrotic cavity", "question_images": ["https://image.prepladder.com/content/izOobYhozxN3CeaMuyJw1737731477.png"], "explanation_images": ["https://image.prepladder.com/content/fi8vT9xpAu9BplmbRgTW1737731524.png", "https://image.prepladder.com/content/QZaoeiTBdkXUJyRhlwLx1737731569.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:636px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Acute osteomyelitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Julie Desimpel Magdalena Posadzy Filip M Vanhoenacker\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Acute-osteomyelitis-in-2-different-patients-Plain-radiograph-a-and-coronal-T2-WI-b_fig2_316867810\" data-tags=\"\" height=\"1791\" src=\"https://image.prepladder.com/content/fi8vT9xpAu9BplmbRgTW1737731524.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n\t\t\t \n\n\t\t\t<ul>\n<li>MRI can reveal early signs of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> osteomyelitis, such as <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> edema, within 1-2 days of infection onset</li>\n<li>In <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> osteomyelitis, the typical<strong> high signal intensity of <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> bone marrow</strong> on <strong>T1-weighted </strong>MRI images<strong> decreases</strong>, reflecting<strong> <span class=\"customMeta\" data-dictid=\"2dd9736fdf16927771849f5a925f7d\">congestion</span> </strong>from fluid and pus.</li>\n<li>In contrast, fluid-sensitive sequences and post-contrast images display <strong>high signal intensity</strong>, indicating the<strong> presence of <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> </strong>and <strong>inflammation</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Chronic osteomyelitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Gaillard F, Verikios N, Sharma R,\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/bony-sequestrum\" data-tags=\"\" height=\"3686\" src=\"https://image.prepladder.com/content/QZaoeiTBdkXUJyRhlwLx1737731569.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n\t\t\t \n\n\t\t\t<p>MRI findings in chronic <span class=\"customMeta\" data-dictid=\"f7bd04046e16927771943526af1e35\">osteomyelitis</span> can reveal:</p>\n<ul>\n<li>Abscesses and <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> tracts.</li>\n<li><strong>Sequestra </strong>(Necrotic bone fragments appear as low signal intensity areas on T1, T2, and STIR sequences and do not show enhancement.)</li>\n<li>Thickened <span class=\"customMeta\" data-dictid=\"ae97d0e84f169277719537f321c02b\">periosteum</span> and cloacae.</li>\n<li><strong>Granulation tissue</strong>,<strong> soft tissue <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> &amp; <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> tracks</strong> exhibit T1 hypointensity, T2 and STIR hyperintensity, and <span class=\"customMeta\" data-dictid=\"4749be0e3f1692777187a4b4100c1d\">enhancement</span> after contrast administration.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Penumbra sign</strong>:</p>\n<ul>\n<li>It indicates low signal intensity in <span class=\"customMeta\" data-dictid=\"6a346f84561692777190430904e7b3\">intraosseous</span> and <span class=\"customMeta\" data-dictid=\"98c8f7f96f1692777199295afb1d35\">subperiosteal</span> abscesses, with high signal intensity in surrounding fluid-sensitive sequences.</li>\n<li>It features a thin enhancing rim of <span class=\"customMeta\" data-dictid=\"9d86b5aa821692777189c750eca8c5\">hypervascular</span> <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue around a central low-intensity pus-filled cavity. <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/pOAS69S1tomxeiZZju961744888999.mp3", "video": ""}, {"text": "A 30-year-old woman presents with pain and swelling in her right elbow following a minor fall. She received a deep tissue massage shortly after the injury. Examination reveals tenderness and limited motion in the elbow. The lateral radiograph of the right elbow joint is shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Osteosarcoma", "correct": false}, {"label": "B", "text": "Aggressive fibromatosis", "correct": false}, {"label": "C", "text": "Osteochondritis dissecans", "correct": false}, {"label": "D", "text": "Myositis ossificans traumatica", "correct": true}], "correct_answer": "D. Myositis ossificans traumatica", "question_images": ["https://image.prepladder.com/content/tzAThWHcHM9m32Wf4KpP1737727954.png"], "explanation_images": ["https://image.prepladder.com/content/tAkAX3BU8i3KmFzujLK31737728037.png", "https://image.prepladder.com/content/58Ru7P1z0L5PwSXayRnG1737728119.png", "https://image.prepladder.com/content/oF1OHz0S5pRvQQGo1Mqd1737728191.png", "https://image.prepladder.com/content/lobzyC5SA7MQDrZMPIao1737728326.png", "https://image.prepladder.com/content/mQ8N19PjFr7lZBqctspE1737728264.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/S5Ccbg8Zow8g710EbFfx1744885014.mp3", "video": ""}, {"text": "A 45-year-old male presents with shoulder pain and weakness after a fall while playing basketball. He reports difficulty lifting his arm when trying to reach overhead. On examination, there is weakness in abduction and external rotation of the shoulder. Which of the following is the gold standard investigation for this condition?", "options": [{"label": "A", "text": "Ultrasound", "correct": false}, {"label": "B", "text": "MRI", "correct": true}, {"label": "C", "text": "CT", "correct": false}, {"label": "D", "text": "X-ray", "correct": false}], "correct_answer": "B. MRI", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/F9ZzXx3ft561f1FBXDdy1737731047.png", "https://image.prepladder.com/content/o4lxGoBOHB6nQWVEgYXB1737731084.png", "https://image.prepladder.com/content/vPNVSUsN8x28CZGvz6d61737731128.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:700px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Normal Image of <span class=\"customMeta\" data-dictid=\"78dfa6942216927771971d0733476f\">rotator</span> cuff</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"ANDREW DIXON\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/normal-shoulder-mri\" data-tags=\"\" height=\"3844\" src=\"https://image.prepladder.com/content/F9ZzXx3ft561f1FBXDdy1737731047.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ahmed Tawfik Ahmad El-Morsy Mohamed Aboelnour\" data-hash=\"\" data-license=\"CC BY-NC 4.0\" data-source=\"https://www.researchgate.net/figure/Partial-interstitial-supraspinatus-tendon-tear-Coronal-oblique-fat-sat_fig2_263517775\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/o4lxGoBOHB6nQWVEgYXB1737731084.png\" width=\"3035\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Partial <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">Thickness</span> Tear</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Appears as a<strong> <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> area of fiber discontinuity </strong>filled with fluid signal on T2W images.<strong> </strong><strong>(Option D)</strong></li>\n<li>Fat-suppressed sequences enhance the visibility of the fluid-filled <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> defect.</li>\n<li>Surface fraying and changes in <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> caliber.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"MEDSCAPE\" data-hash=\"\" data-license=\"CC0\" data-source=\"https://upload.wikimedia.org/wikipedia/commons/9/9f/Full_Thickness_Tear.jpg\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/vPNVSUsN8x28CZGvz6d61737731128.png\" width=\"3796\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Full <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">Thickness</span> Tear</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Appears as a<strong> <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> discontinuity in the tendon</strong>, extending from the <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> to the bursal surface. <strong>(Option C)</strong></li>\n<li>Seen as fluid signal intensity on T2-weighted (T2W) images.</li>\n<li>Fluid may be present in the subacromial-subdeltoid (SASD) <span class=\"customMeta\" data-dictid=\"305c26a07b1692777183e163c48e3c\">bursa</span> and joint space.</li>\n<li>Secondary signs include<strong> <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> retraction</strong>, <strong>superior translation of the humeral head</strong>, and<strong> muscle atrophy</strong>, can be seen.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ye3ka4tRX8Lg6ntsv0U21744888616.mp3", "video": ""}, {"text": "In the given MRI image of the knee identify the posterior cruciate ligament.", "options": [{"label": "A", "text": "a", "correct": false}, {"label": "B", "text": "b", "correct": true}, {"label": "C", "text": "c", "correct": false}, {"label": "D", "text": "d", "correct": false}], "correct_answer": "B. b", "question_images": ["https://image.prepladder.com/content/h6qZVnVCJ3oh9UIPrivo1737730824.png"], "explanation_images": ["https://image.prepladder.com/content/nT0gxh4kouTyuGcufFM71737730889.png", "https://image.prepladder.com/content/nmcc8haEXW9kTLd8q8Sk1737730928.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">resonance</span> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> </strong>(MRI) provides detailed images of the <strong>soft tissue </strong>structures, such as <strong>menisci</strong>, <strong>ligaments</strong>, and <strong>cartilage</strong>, as well as the <strong>bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> </strong>in the knee.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Structure </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>MRI appearance </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>The <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"0faa43e76516927771851bff22a1e2\">cruciate</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (ACL) </strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Appears as a <strong>straight band </strong>parallel to the <span class=\"customMeta\" data-dictid=\"605903750116927771905ca0bfe3c7\">intercondylar</span> roof in a <span class=\"customMeta\" data-dictid=\"862a709fba1692777198c35e274398\">sagittal</span> MRI.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>The <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"0faa43e76516927771851bff22a1e2\">cruciate</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (PCL) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Appears as a <strong>homogenous <span class=\"customMeta\" data-dictid=\"9912c2745b1692777189895dadd770\">hypointense</span> </strong>structure and is supported by the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"dd6bdf5060169277719220c20cb189\">meniscofemoral</span> ligaments.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Menisci </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <strong>menisci </strong>are seen as<strong> low-intensity structures</strong> in the <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> appearing as a “<strong>triangle</strong>” or “<strong>wedge</strong>” in the <span class=\"customMeta\" data-dictid=\"dad5b2152216927771851a3d10cd41\">coronal</span> view and like a <strong>“bowtie” </strong>in the <span class=\"customMeta\" data-dictid=\"862a709fba1692777198c35e274398\">sagittal</span> view.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Appears as a <strong>hypointense lining </strong>of the bone.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patella </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>When the knee is fully extended, the normal <span class=\"customMeta\" data-dictid=\"615557ed3a169277719497f86e830b\">patella</span> is positioned laterally in relation to the trochlea.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/OkJCkhh2zV3PwqCmgb7q1744888018.mp3", "video": ""}, {"text": "A 28-year-old male athlete presents with a right knee injury sustained during a soccer match. He reports hearing a “pop” sound at the time of injury and is experiencing significant pain and swelling in the knee. On physical examination, there is moderate effusion, and the patient is unable to fully extend the knee. An MRI of the knee is performed, revealing the following findings: Based on the MRI findings, which of the following statements regarding the patient's injury is most accurate?", "options": [{"label": "A", "text": "The presence of edema and hyperintense signal suggests a complete ACL tear", "correct": false}, {"label": "B", "text": "An ACL angle greater than 15° indicates a partial rupture.", "correct": false}, {"label": "C", "text": "The \"Empty Notch Sign\" observed on MRI indicates an ACL avulsion injury.", "correct": true}, {"label": "D", "text": "A hyperintense signal in the ACL with a normal angle suggests a complete tear rather than a partial tear.", "correct": false}], "correct_answer": "C. The \"Empty Notch Sign\" observed on MRI indicates an ACL avulsion injury.", "question_images": ["https://image.prepladder.com/content/fjtFbxd6cbQvAJHhzmBQ1737730575.png"], "explanation_images": ["https://image.prepladder.com/content/S3xUR6YFmhFYusH1xbdF1737730695.png", "https://image.prepladder.com/content/ZgHlQX3TJJTEFuIG4qXB1737730735.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Anterior <span class=\"customMeta\" data-dictid=\"0faa43e76516927771851bff22a1e2\">cruciate</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> injury</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Marios G Lykissas, George I Mataliotakis, Nikolaos Paschos, Christos Panovrakos, Alexandros E Beris and Christos D Papageorgiou\" data-hash=\"\" data-license=\"CC BY-SA 2.0\" data-source=\"https://en.m.wikipedia.org/wiki/File:MRT_ACL_PCL_01.jpg\" data-tags=\"\" height=\"3329\" src=\"https://image.prepladder.com/content/S3xUR6YFmhFYusH1xbdF1737730695.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n\t\t\t \n\n\t\t\t<ul>\n<li>Edema and <span class=\"customMeta\" data-dictid=\"6873f1dcce16927771890fcdc546b0\">hyperintense</span> signal on T2 or fat-saturated PD images.</li>\n<li>Visible tear or <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> contour, often in the middle portion (midsubstance) of the ligament.</li>\n<li>ACL fibers appear less steep than the <span class=\"customMeta\" data-dictid=\"605903750116927771905ca0bfe3c7\">intercondylar</span> (Blumensaat) line; <strong>ACL angle &gt;15° suggests rupture.</strong></li>\n<li><strong>Empty <span class=\"customMeta\" data-dictid=\"80dc1890d11692777193322fc863b1\">Notch</span> Sign</strong>: Fluid signal at the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"ccd357daaf16927771825777ea6a0d\">attachment</span> site in the <span class=\"customMeta\" data-dictid=\"605903750116927771905ca0bfe3c7\">intercondylar</span> notch, indicating avulsion. <strong>(Option C)</strong></li>\n<li><strong>Partial Tear</strong>: Normal ACL angle but with a <span class=\"customMeta\" data-dictid=\"6873f1dcce16927771890fcdc546b0\">hyperintense</span> signal suggests partial <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> rather than complete tear.</li>\n<li>A torn ACLstump will give a \"Bell-hammer Sign.” usually seen in partial tear</li>\n<li><strong>Gap Sign</strong>: Fluid or gap between the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"ca4c4e935616927771849e13b0396f\">condyle</span> and mid-ACL, seen in isolated <span class=\"customMeta\" data-dictid=\"0b858004a11692777196bac353c12b\">posterolateral</span> <span class=\"customMeta\" data-dictid=\"0b0057954d1692777183cde3b4afbf\">bundle</span> tears.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Posterior <span class=\"customMeta\" data-dictid=\"0faa43e76516927771851bff22a1e2\">cruciate</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> injury</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Vaishnavi R Waghe Priya Tikhile Deepali swapnil Patil\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/MRI-showing-PCL-tear-MRI-Magnetic-resonance-imaging-PCL-Posterior-cruciate-ligament_fig3_380366516\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/ZgHlQX3TJJTEFuIG4qXB1737730735.png\" width=\"3887\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>PCL often remains intact (~70%) despite partial or complete disruption.</li>\n<li>Enlarged and swollen PCL with an <strong>AP <span class=\"customMeta\" data-dictid=\"afb15e4a331692777186e495b370a1\">diameter</span> &gt;7 mm</strong> in the <strong>vertical portion on</strong> <strong>sagittal images</strong> suggests a tear.</li>\n<li>A <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> shift of more than 2-3 mm in the mid-medial <span class=\"customMeta\" data-dictid=\"ce3edddb5116927771844c030f3c1e\">compartment</span> indicates injury</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/7gvqnICLhAy5AXdE3mVP1744887749.mp3", "video": ""}, {"text": "A 45-year-old female presents with chronic knee pain and occasional joint swelling and clicking in the joint. She reports no history of trauma. The MRI findings are shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Horizontal meniscal tear with parameniscal cyst", "correct": true}, {"label": "B", "text": "Longitudinal vertical tear", "correct": false}, {"label": "C", "text": "Radial Tear", "correct": false}, {"label": "D", "text": "Bucket Handle Tear", "correct": false}], "correct_answer": "A. Horizontal meniscal tear with parameniscal cyst", "question_images": ["https://image.prepladder.com/content/Dgt44SlSfymrrm79MPrq1737730414.png"], "explanation_images": ["https://image.prepladder.com/content/1tbxD3Klm4xOtI5voVP31737730455.png", "https://image.prepladder.com/content/GYwCeLIN9IP0JdX9DqQg1737730362.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:604px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Meniscal tear</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Key Characteristics on MRI</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Horizontal Tear</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Horizontal line of high signal intensity; involves <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> surfaces and can cause parameniscal cysts.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Longitudinal Tear </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vertically oriented tear; runs <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to the <span class=\"customMeta\" data-dictid=\"526b3e942016927771928828b6c34f\">meniscus</span> <span class=\"customMeta\" data-dictid=\"3c28fd47f71692777182efbbaa5f6d\">axis</span> and often involves the red zone. Usually <span class=\"customMeta\" data-dictid=\"18034e0517169277720002aaa66d36\">traumatic</span> in origin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radial Tear </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Perpendicular to the meniscus, disrupts hoop strength, seen as truncation of free edge, does not <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> parameniscal cysts.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bucket Handle Tear </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Longitudinal tear with fragment migration; shows a \"double PCL\" sign or displaced fragment in the <span class=\"customMeta\" data-dictid=\"605903750116927771905ca0bfe3c7\">intercondylar</span> notch.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/GYwCeLIN9IP0JdX9DqQg1737730362.png\" width=\"4168\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/UOLUB3XjmPsNlU00iE571744887573.mp3", "video": ""}, {"text": "A 65-year-old man presents with progressive back pain, weight loss, and leg weakness. There is tenderness over the thoracic spine, raising suspicion of a spinal tumor. What is the investigation of choice to evaluate for a spinal tumor?", "options": [{"label": "A", "text": "X-ray of the thoracic spine", "correct": false}, {"label": "B", "text": "CT scan of the thoracic spine", "correct": false}, {"label": "C", "text": "MRI of the thoracic spine", "correct": true}, {"label": "D", "text": "PET scan", "correct": false}], "correct_answer": "C. MRI of the thoracic spine", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/J9mCBPj075gQ4qiK2iMX1737729798.png", "https://image.prepladder.com/content/FwxtUHkQY7sDEgEndAew1737729890.png", "https://image.prepladder.com/content/0RmNSr3uZT0eTmsNM0ja1737730076.png", "https://image.prepladder.com/content/4kStANw0JWAsIBLJUdcX1737730039.png", "https://image.prepladder.com/content/v0kAqsq5H4O5NL5OUMnH1737729979.png", "https://image.prepladder.com/content/nJerQtua8vF9C3qFGYpu1737730183.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:687px\">\n<thead>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>T1-Weighted Imaging</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>T2-Weighted Imaging</strong></p>\n</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Highlights fat, which appears bright (high signal)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Highlights fluid</strong>, which appears bright (high signal)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Structures with water content appear <span class=\"customMeta\" data-dictid=\"9912c2745b1692777189895dadd770\">hypointense</span> (dark).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Structures with low water content remain hypointense.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Useful for assessing:</p>\n<ul>\n<li>Normal soft-tissue anatomy</li>\n<li>Fat-containing lesions</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Effective for identifying:</p>\n<ul>\n<li>Myocardial edema</li>\n<li>Pathological changes in tissues (e.g., tumors, inflammation, trauma).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/q9Q2bZDjZAgKoH0hikIu1744886147.mp3", "video": ""}, {"text": "A 28-year-old male presents to the hospital after sustaining multiple fractures in a motorcycle accident. Within 36 hours of the trauma, he develops tachycardia, fever, confusion, and a PaO of 55 mm Hg. A chest X-ray is taken and is shown below. He has petechial rashes noted on his conjunctiva and neck, and his platelet count is 120,000/mm³. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Pulmonary edema", "correct": false}, {"label": "B", "text": "Aspiration pneumonia", "correct": false}, {"label": "C", "text": "Acute respiratory distress syndrome", "correct": true}, {"label": "D", "text": "Transfusion-related acute lung injury", "correct": false}], "correct_answer": "C. Acute respiratory distress syndrome", "question_images": ["https://image.prepladder.com/content/48pob0qTrgjqnd3DFzbe1737729386.png"], "explanation_images": ["https://image.prepladder.com/content/zrckqxpNMEXUvTOPxfm11737729416.png", "https://image.prepladder.com/content/mVXNSCuk6xJ0mFqz5jds1737729512.png", "https://image.prepladder.com/content/nPMBUdmjqXww3z8ZaQ0l1737729586.png", "https://image.prepladder.com/content/eE0UoohMIiDCzl47Q6lV1737729639.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:735px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">Distress</span> Syndrome (ARDS)/Fat Embolism</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Defined as post-traumatic <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> syndrome<strong> </strong>occurring within 72 hours of skeletal trauma.</li>\n<li>Typically manifests <strong>within 24-48 hours</strong> but can be delayed.</li>\n<li>Dreaded complication, often associated with <strong>multiple fractures</strong>, major bone fractures, <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> fractures, and multisystem injuries (chest, abdomen, head injuries).</li>\n<li>Affects 10-45% of multiple <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> cases with 11% mortality.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Young adults</strong> (20-30 years): <strong>Long bone fractures</strong></li>\n<li><strong>Elderly: </strong>Pelvic fractures</li>\n<li><strong>Iatrogenic cause: </strong>Occurs after reamed <span class=\"customMeta\" data-dictid=\"5b22285eec169277719026820db11c\">intramedullary</span> (IM) <span class=\"customMeta\" data-dictid=\"cb2d373f701692777193324602b6fa\">nailing</span> of the femur.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sources of Fat</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It can be from 2 sources:</p>\n<ol>\n<li><strong>Mechanical theory:</strong> Fat from <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> (most accepted).</li>\n<li><strong>Biochemical theories:</strong></li>\n</ol>\n<ol>\n<li><strong>Obstructive theory: </strong>Agglutination of chylomicrons in <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> acts as <span class=\"customMeta\" data-dictid=\"586c1eff6e16927771872ba5871abe\">emboli</span> (less accepted).</li>\n<li><strong>Toxic theory: </strong>Free <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acids destroy pneumocytes, causing ARDS.</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Following injury, fat from <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> or <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> <span class=\"customMeta\" data-dictid=\"36e1a07ab01692777180db73f01e84\">agglutination</span> enters injured vessels and travels as emboli, leading to various clinical manifestations.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gurd’s Criteria For Fat Embolism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Major criteria:</strong></p>\n<ol>\n<li>Axillary and <span class=\"customMeta\" data-dictid=\"335f16a33c16927771992f5c55bc4d\">subconjunctival</span> petechiae</li>\n<li>PaO &lt;60 mm Hg</li>\n<li>CNS depression</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Minor criteria:</strong></p>\n<ol>\n<li>Pulse &gt;110/min</li>\n<li>Pyrexia &gt;38.5°C</li>\n<li>Retinal embolism</li>\n<li>Fat in urine</li>\n<li>Reduced <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> count</li>\n<li>Increased ESR</li>\n<li>Fat globules in sputum</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic criteria: </strong>At least 1 major <span class=\"customMeta\" data-dictid=\"9167b944ea169277718582367e0915\">criterion</span> + 4 minor criteria required for diagnosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Chest X-ray: </strong>Snowstorm appearance (pathognomonic).</li>\n<li>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"JAMES HAILMAN\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Acute_respiratory_distress_syndrome#/media/File:ARDSSevere.png\" data-tags=\"\" height=\"3994\" src=\"https://image.prepladder.com/content/zrckqxpNMEXUvTOPxfm11737729416.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</li>\n<li>PaO &lt;60 mm Hg.</li>\n<li>Platelet count &lt;1.5 lakhs.</li>\n<li><strong>ECG: </strong>Prominent S-wave.</li>\n<li><strong>Gurd test: </strong>Isolation of fat <span class=\"customMeta\" data-dictid=\"586c1eff6e16927771872ba5871abe\">emboli</span> from the blood.</li>\n<li><strong>Other lab findings: </strong>Anemia, hypocalcemia.</li>\n<li><strong>CT scan and MRI: </strong>Assess severity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic <span class=\"customMeta\" data-dictid=\"1a0a43d74e16927772004473a05ae3\">triad</span> (TPR mnemonic)</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>T</strong>hrombocytopenia</li>\n<li><strong>P</strong>aO &lt;60 mm Hg</li>\n<li><strong>R</strong>ashes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Respiratory support: </strong>Oxygen or <span class=\"customMeta\" data-dictid=\"072a58ab7d169277720130e58f9614\">ventilator</span> support to restore PaO.</li>\n<li><strong>Drug therapy:</strong>\n<ul>\n<li><strong>Steroids: </strong>Reduce lung <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and improve gas exchange.</li>\n<li><strong>Heparin: </strong>Lipolytic and <span class=\"customMeta\" data-dictid=\"257da9409416927771815e64ee5df1\">antiplatelet</span> agent.</li>\n<li><strong>Low <span class=\"customMeta\" data-dictid=\"b2df2436bf1692777193d90e9c0132\">molecular weight</span> dextran: </strong>Increases <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> volume.</li>\n<li>Antibiotics and other supportive care.</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Definitive <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> treatment: </strong>Early <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> to prevent worsening.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/XWDIYBfoZLAeL8KkPPIM1744885453.mp3", "video": ""}, {"text": "A 3-year-old child is brought to the clinic with concerns about foot deformities. An anteroposterior radiograph of the feet is taken, as shown below. The child also exhibits episodes of painful swelling in the shoulders and neck, leading to difficulty in movement. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Soft tissue sarcoma", "correct": false}, {"label": "B", "text": "Progressive osseous heteroplasia", "correct": false}, {"label": "C", "text": "Aggressive juvenile fibromatosis", "correct": false}, {"label": "D", "text": "Fibrodysplasia ossificans progressiva", "correct": true}], "correct_answer": "D. Fibrodysplasia ossificans progressiva", "question_images": ["https://image.prepladder.com/content/AoVYiRbRqiPRohZZZvtv1737728464.png"], "explanation_images": ["https://image.prepladder.com/content/9kmLuVaxWHVVtNwmvOAz1737728532.png", "https://image.prepladder.com/content/OfCWMW3xs22EnivbWDVp1737728595.png", "https://image.prepladder.com/content/9udlTVoq12xZhhvgjUFt1737729098.png", "https://image.prepladder.com/content/Ddas1aiw3gz9hEMPmAC71737729144.png", "https://image.prepladder.com/content/P5llGA1lnlkmzOgcNLYA1737729193.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/JuTRVNHQ8l8VAcH01RWB1744885282.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 27 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 8</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Bone And Imaging-Previous Year Questions - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 8</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 8 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which among the following is pressure epiphysis", "options": [{"label": "A", "text": "Head of Humerus", "correct": true}, {"label": "B", "text": "Elbow joint", "correct": false}, {"label": "C", "text": "Wrist joint", "correct": false}, {"label": "D", "text": "Sternum", "correct": false}], "correct_answer": "A. Head of Humerus", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common site of an osteoporotic fracture?", "options": [{"label": "A", "text": "Vertebrae fracture", "correct": true}, {"label": "B", "text": "Subtrochanteric fracture", "correct": false}, {"label": "C", "text": "Glenoid fracture", "correct": false}, {"label": "D", "text": "Midshaft of humerus fracture", "correct": false}], "correct_answer": "A. Vertebrae fracture", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A – V\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23 year old male reports severe pain, swelling, and an inability to extend his knee after a fall. What is the diagnosis?", "options": [{"label": "A", "text": "Patellar fracture", "correct": true}, {"label": "B", "text": "Rheumatoid arthritis", "correct": false}, {"label": "C", "text": "Hemarthrosis of knee", "correct": false}, {"label": "D", "text": "Tibial condylar fracture", "correct": false}], "correct_answer": "A. Patellar fracture", "question_images": ["https://image.prepladder.com/content/apsYapzF7NxaCLCh5OyU1717763691.png"], "explanation_images": ["https://image.prepladder.com/content/x74zaGiiEmipU8dK75gO1717763789.png", "https://image.prepladder.com/content/KKHFfpL6gcc0BsV5tvLK1717763798.png"], "explanation": "<p>Correct Option A - Patellar fractu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the zone of calcification in the image given below.", "options": [{"label": "A", "text": "A", "correct": true}, {"label": "B", "text": "B", "correct": false}, {"label": "C", "text": "C", "correct": false}, {"label": "D", "text": "D", "correct": false}], "correct_answer": "A. A", "question_images": ["https://image.prepladder.com/content/GTiQ8B606cyTfCx6m1f41717763893.png"], "explanation_images": ["https://image.prepladder.com/content/waJbjN7asQVCsNOgs8Ig1717763957.png"], "explanation": "<p>Correct Option A -A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 22-year-old male presents with thigh pain. A CT scan was done as given below. Identify the condition.?", "options": [{"label": "A", "text": "Osteomalacia Option 1*", "correct": false}, {"label": "B", "text": "Osteosarcoma", "correct": false}, {"label": "C", "text": "Ewings sarcoma", "correct": false}, {"label": "D", "text": "Chronic Osteomyelitis", "correct": true}], "correct_answer": "D. Chronic Osteomyelitis", "question_images": ["https://image.prepladder.com/content/SObcc3uY14GxZ4ewfXLc1718023248.png"], "explanation_images": [], "explanation": "<p>Correct Option D - Chronic O\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the structure marked in the given image.", "options": [{"label": "A", "text": "Anterior rib", "correct": false}, {"label": "B", "text": "Posterior rib", "correct": true}, {"label": "C", "text": "Costal cartilage", "correct": false}, {"label": "D", "text": "Right descending pulmonary artery", "correct": false}], "correct_answer": "B. Posterior rib", "question_images": ["https://image.prepladder.com/content/tOZfq3bKR46HXXMsVYqD1717764858.png"], "explanation_images": ["https://image.prepladder.com/content/G5ZPyi5hGYk1upQqQTAQ1717764916.png"], "explanation": "<p>Correct Option B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "At what age in women DEXA scan is done routinely ?", "options": [{"label": "A", "text": "At 50 years", "correct": false}, {"label": "B", "text": "At 55 years", "correct": false}, {"label": "C", "text": "At 60 years", "correct": false}, {"label": "D", "text": "At 65 years", "correct": true}], "correct_answer": "D. At 65 years", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - At 65\n<table>\n<thead>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>T-Score</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Interpretation</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\">Above -1.0</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Normal</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">-1.0 to -2.5</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Osteopenia (low bone density)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Below -2.5</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Osteoporosis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Following a fall in the bathroom , an elderly lady is diagnosed with fractured neck of the femur . Which of the following coexisting conditions most likely predisposed to this?", "options": [{"label": "A", "text": "Osteoporosis", "correct": true}, {"label": "B", "text": "Osteopetrosis", "correct": false}, {"label": "C", "text": "Osteoarthritis", "correct": false}, {"label": "D", "text": "Osteomalacia", "correct": false}], "correct_answer": "A. Osteoporosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - O\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 18 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 14</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Complications Of Fractures-Complications In Orthopedics - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 14</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. 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The surgeon discusses two options: Syme’s amputation and Boyd’s amputation. Which statement accurately describes a key feature of each procedure?", "options": [{"label": "A", "text": "Syme’s allows for full weight-bearing; Children benefit greatly from Boyd’s.", "correct": false}, {"label": "B", "text": "Syme’s involves talectomy and fusion; Boyd’s preserves the distal physis.", "correct": false}, {"label": "C", "text": "Boyd’s involves talectomy and fusion; Syme’s uses a posterior flap.", "correct": true}, {"label": "D", "text": "Syme’s offers stabilization of the heel pad; Boyd’s is performed above the ankle.", "correct": false}], "correct_answer": "C. Boyd’s involves talectomy and fusion; Syme’s uses a posterior flap.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/u6pzuCh2aiFoNQAMStk01738316268.png", "https://image.prepladder.com/content/Si2wO9w060SErZqocefW1738316301.png", "https://image.prepladder.com/content/YqRXCl6pMfgQ1eHmdX6L1738316423.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:744px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Syme’s Amputation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Boyd’s amputation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Syme’s <span class=\"customMeta\" data-dictid=\"9dfe4d42641692777181673eb73924\">amputation</span> is performed <strong>above the ankle</strong>. <strong>(Option D ruled out)</strong></li>\n<li>The level of bone section is 0.6 cm <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> to the ankle joint.</li>\n<li>It preserves the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> physis, providing good function.</li>\n<li>Children benefit greatly from this procedure. <strong>(Option A ruled out)</strong></li>\n<li>Men generally accept it well, but women may find it cosmetically unappealing.</li>\n<li>The indications for the surgery are limited and it is technically difficult.</li>\n<li>A long <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> is used, including the heel skin and fat pad.</li>\n<li>The bones are cut just above the <span class=\"customMeta\" data-dictid=\"57986121e1169277719156c8d3120e\">malleoli</span> for stability.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Boyd’s <span class=\"customMeta\" data-dictid=\"9dfe4d42641692777181673eb73924\">amputation</span> involves\n\t\t\t\t<ul>\n<li>Removal of the <span class=\"customMeta\" data-dictid=\"ee55b45c5f1692777200dd3dd0256a\">talus</span> (talectomy)</li>\n<li>The <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> of the <span class=\"customMeta\" data-dictid=\"c8b77c76861692777183e8bcbc3c5a\">calcaneus</span> to the <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> (calcaneotibial arthrodesis). <strong>(Option B ruled out)</strong></li>\n</ul>\n</li>\n<li>It <strong>enables full weight-bearing</strong>.</li>\n<li>It offers <span class=\"customMeta\" data-dictid=\"6694ddb1db1692777199c9a1e38bf0\">stabilization</span> of the <span class=\"customMeta\" data-dictid=\"0f66ada5d616927771898f530a8510\">heel pad</span> while providing support for a prosthesis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"808\" src=\"https://image.prepladder.com/content/u6pzuCh2aiFoNQAMStk01738316268.png\" width=\"807\"/>\n<p><img alt=\"\" data-author=\"Nora Laban\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/syme-amputation\" data-tags=\"\" height=\"807\" src=\"https://image.prepladder.com/content/Si2wO9w060SErZqocefW1738316301.png\" width=\"361\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"421\" src=\"https://image.prepladder.com/content/YqRXCl6pMfgQ1eHmdX6L1738316423.png\" width=\"195\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/qlxSsrMg1fl5wOtaw0dI1745754929.mp3", "video": ""}, {"text": "A 28-year-old male is brought to the emergency department after a motorcycle accident. On examination, he has an open fracture of the right tibia with a 3 cm skin wound. There is moderate soft tissue damage, but no flaps or avulsions are present. Which Gustilo and Anderson classification best describes this injury?", "options": [{"label": "A", "text": "Type I", "correct": false}, {"label": "B", "text": "Type II", "correct": true}, {"label": "C", "text": "Type III", "correct": false}, {"label": "D", "text": "Type III A", "correct": false}], "correct_answer": "B. Type II", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Y0DyzOgbe0lFXXyVc0wg1738314252.png", "https://image.prepladder.com/content/sKbwZGjnYFhE1TFJi96y1738314338.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:763px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>I </strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Skin wound <strong>less than 1 cm</strong>, clean, simple <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> pattern</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>II </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Skin wound <strong>more than 1 cm</strong>, soft-tissue damage not extensive, no flaps or avulsions, simple <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> pattern</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>III </strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High-energy injury involving extensive soft-tissue damage, or multifragmentary fracture, <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> fractures, or bone loss irrespective of wound size, or severe crush injuries, or <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> injury requiring repair, or severe <span class=\"customMeta\" data-dictid=\"22b9188ade169277718581ce9dc589\">contamination</span> including farmyard injuries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>III A </strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adequate soft-tissue cover of bone despite extensive <strong>soft-tissue damage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>III B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extensive soft-tissue injury with <strong>periosteal <span class=\"customMeta\" data-dictid=\"85cb03377b1692777199d46846ce58\">stripping</span> and bone exposure</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>III C</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High-energy injury and <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">Vascular</span> injuries requiring<strong> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> repair</strong> and extensive soft-tissue damage</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/hY94NwFvmH8tbLIBJ0eb1745754417.mp3", "video": ""}, {"text": "A 35-year-old man presents to the emergency department with an open tibial fracture following a motorcycle accident. The wound is 4 cm long with moderate soft tissue damage but no flaps or avulsions. After an initial assessment, what is the most appropriate next step in the management of this patient's injury?", "options": [{"label": "A", "text": "Immediate internal fixation", "correct": false}, {"label": "B", "text": "Application of a plaster cast", "correct": false}, {"label": "C", "text": "Wound debridement and irrigation", "correct": true}, {"label": "D", "text": "Administration of tetanus prophylaxis", "correct": false}], "correct_answer": "C. Wound debridement and irrigation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:728px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management Steps</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>I: Emergency Care</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Control bleeding</li>\n<li><strong>Wound care: </strong>Wash the wound under strict <span class=\"customMeta\" data-dictid=\"50ca3536ab16927771820138ef02f8\">aseptic</span> conditions with clean tap water or saline.\n\t\t\t\t<ul>\n<li>Cover with <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> dressing.</li>\n</ul>\n</li>\n<li><strong>Splinting:</strong> Apply a <span class=\"customMeta\" data-dictid=\"7f606f911b1692777199eb69ab67c5\">splint</span> to <span class=\"customMeta\" data-dictid=\"87bf05a56616927771893b9550e8ad\">immobilize</span> the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> and prevent further soft tissue damage.</li>\n<li><strong>Antibiotics &amp; <span class=\"customMeta\" data-dictid=\"64dfe4fca51692777200a7ffbc44bb\">Tetanus</span> prophylaxis</strong></li>\n<li>Pain management</li>\n<li><strong>Imaging:</strong> Perform X-rays to evaluate the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> and to plan further treatment.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>II: <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">Definitive</span> Care</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Wound debridement: </strong>Perform thorough debridement of all devitalized tissue. This may need to be repeated.</li>\n<li><strong>Fracture reduction &amp; stabilization:</strong>\n<ul>\n<li>External fixation: Provides stability and permits access to soft tissues. Useful for severe soft tissue injuries.</li>\n<li>Internal fixation: Used for more stable fractures. Becoming more common in trauma centers.</li>\n<li>Plaster immobilization: For cases with moderate-size wounds where stable reduction can be achieved.</li>\n</ul>\n</li>\n<li><strong>Wound closure:</strong>\n<ul>\n<li>Primary closure: For clean wounds debrided within 6-8 hours.</li>\n<li>Delayed primary closure: For doubtful wounds, observe for 2-3 days before closing.</li>\n<li>Secondary intention: For infected wounds or extensive soft tissue damage.</li>\n</ul>\n</li>\n<li><strong>Bone grafting: </strong>May be necessary for bone loss or to promote union.</li>\n<li><strong>Vascular repair: </strong>If <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> injury is present, repair is crucial for limb salvage.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>III: Rehabilitation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Early mobilization</li>\n<li>Joint exercises &amp; muscle strengthening</li>\n<li><strong>Functional rehabilitation: </strong>Gradually increase weight-bearing and return to normal activities as <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> progresses.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/FQDBb2EEZeqgyAdrpZJY1743316575.mp3", "video": ""}, {"text": "Which of the following statements is INCORRECT regarding malunion of fractures?", "options": [{"label": "A", "text": "Fractures in diaphysis are more prone to undergo malunion than fractures near metaphysis", "correct": false}, {"label": "B", "text": "The most common cause of malunion is improper initial treatment of the fracture.", "correct": false}, {"label": "C", "text": "Malunion in children always requires corrective osteotomy or osteoclasis to prevent functional limitations.", "correct": true}, {"label": "D", "text": "The clavicle and distal radius are common sites for malunion.", "correct": false}], "correct_answer": "C. Malunion in children always requires corrective osteotomy or osteoclasis to prevent functional limitations.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:729px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fracture healed in an improper position, leading to <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> and potential functional limitations</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Improper initial treatment, inadequate reduction, unchecked muscle pull, excessive comminution</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Clavicle</li>\n<li>Distal <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> (Colles fracture)</li>\n<li>Supracondylar humerus</li>\n<li>Long bones (femur, tibia)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Adult-</strong> Often requires <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention for significant <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> or functional impairment; corrective <span class=\"customMeta\" data-dictid=\"d1ed4aacdf1692777194c9aa2fc2ac\">osteotomy</span> is a common approach</li>\n<li><strong>Children-</strong> Greater potential for bone remodeling; management often more conservative; <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention (osteoclasis or corrective osteotomy) reserved for <strong>severe cases or older children</strong> <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Factors Affecting Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Age</li>\n<li>Location of <span class=\"customMeta\" data-dictid=\"e9c1a7fec316927771915c5460d9a7\">malunion</span> (Metaphyseal fractures heal better than <span class=\"customMeta\" data-dictid=\"3a5e357f5b1692777186ef94b008d8\">diaphyseal</span> fractures)</li>\n<li>Degree of angulation</li>\n<li>Functional impairment</li>\n<li>Plane of deformity</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/BAMW0iwV7DoybLFCP7Fw1745754598.mp3", "video": ""}, {"text": "A 35-year-old male presented with a history of a femur fracture from a road traffic accident 8 months ago. He was treated with a cast, but now has a deformity with leg shortening and limping. An X-ray shows abnormal alignment of the fractured bone. Which of the following is the most appropriate management for this patient?", "options": [{"label": "A", "text": "Continue conservative treatment", "correct": false}, {"label": "B", "text": "Open reduction and internal fixation (ORIF) with bone grafting", "correct": true}, {"label": "C", "text": "Physical therapy to correct the deformity", "correct": false}, {"label": "D", "text": "External fixation for deformity correction", "correct": false}], "correct_answer": "B. Open reduction and internal fixation (ORIF) with bone grafting", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/RyE2l5ldwYjWYtHr0MOh1738314575.png", "https://image.prepladder.com/content/YItuJMgjjYY1u3ang8kB1738314599.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/gOzdwneswCaepCKkh9081743317636.mp3", "video": ""}, {"text": "A 50-year-old patient presents with pain and inability to bear weight 10 months after a tibial fracture. Imaging shows a persistent gap at the fracture site with no signs of callus formation. Which of the following best describes this condition?", "options": [{"label": "A", "text": "Delayed union", "correct": false}, {"label": "B", "text": "Malunion", "correct": false}, {"label": "C", "text": "Non-union", "correct": true}, {"label": "D", "text": "Pseudoarthrosis", "correct": false}], "correct_answer": "C. Non-union", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/4AkjhH8EEsFBdOklLcap1738314670.png", "https://image.prepladder.com/content/zpDQXggSK5Ib4nZP6Ceq1738314767.png", "https://image.prepladder.com/content/KuczQ44TxKre31Jjgacv1738314879.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/IvwEph96LN6lrGAtejSp1743415385.mp3", "video": ""}, {"text": "A 45-year-old male presents with a humeral shaft fracture that has not healed after 9 months despite conservative treatment. Imaging shows poor bone formation at the fracture site. Which of the following is the best next step in management?", "options": [{"label": "A", "text": "Continue conservative treatment with a brace", "correct": false}, {"label": "B", "text": "Electrical stimulation therapy", "correct": false}, {"label": "C", "text": "Open reduction and internal fixation (ORIF) with bone grafting", "correct": true}, {"label": "D", "text": "Intramedullary nailing", "correct": false}], "correct_answer": "C. Open reduction and internal fixation (ORIF) with bone grafting", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Ud7ZXCTjN19iSttq6wGr1743415491.mp3", "video": ""}, {"text": "Which of the following best describes the pathophysiological sequence leading to Volkmann's ischemic contracture in its most common location?", "options": [{"label": "A", "text": "Venous thrombosis → muscle edema → nerve compression → contracture of the calf muscles", "correct": false}, {"label": "B", "text": "Arterial insufficiency → compartment syndrome → myonecrosis → fibrosis of the forearm flexor muscles", "correct": true}, {"label": "C", "text": "Nerve entrapment → muscle atrophy → joint stiffness → contracture of the intrinsic hand muscles", "correct": false}, {"label": "D", "text": "Lymphatic obstruction → tissue swelling → collagen deposition → contracture of the upper arm extensors", "correct": false}], "correct_answer": "B. Arterial insufficiency → compartment syndrome → myonecrosis → fibrosis of the forearm flexor muscles", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/NvUtQbZvAxb7XxxYBkGn1738315014.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/BojUhNYUWnYvU7HiGTHm1743415852.mp3", "video": ""}, {"text": "A 12-year-old boy presents with flexion contracture of all five digits and the wrist, along with sensory impairment in the median and ulnar nerve distributions, following a supracondylar humerus fracture. According to Tsuge's classification, which stage of Volkmann's contracture does this presentation most likely represent?", "options": [{"label": "A", "text": "Mild stage", "correct": false}, {"label": "B", "text": "Moderate stage", "correct": true}, {"label": "C", "text": "Severe stage", "correct": false}, {"label": "D", "text": "Threatened stage", "correct": false}], "correct_answer": "B. Moderate stage", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:724px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mild </strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Localized <span class=\"customMeta\" data-dictid=\"3c13e3c8e91692777185822d4393f9\">contracture</span> affecting parts of the <strong>flexor digitorum profundus</strong>.</li>\n<li>Typically causes <strong>flexion of 2 or 3 fingers</strong>.</li>\n<li>Commonly involves the <strong>middle</strong> and <strong>ring fingers</strong>.</li>\n<li><strong>Minimal to no <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> loss</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Classic <span class=\"customMeta\" data-dictid=\"3c13e3c8e91692777185822d4393f9\">contracture</span> - involves <strong>flexor digitorum profundus</strong> and <strong>flexor pollicis longus</strong>.</li>\n<li><strong>Flexor digitorum superficialis</strong>, <strong>flexor carpi ulnaris</strong>, and <strong>flexor carpi radialis</strong> may also be affected.</li>\n<li>Muscle <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> leads to a <strong>claw hand</strong> <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> (<strong>flexion of all five digits and wrist</strong>).</li>\n<li>Sensory <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> occurs in areas supplied by the <strong>median</strong> and <strong>ulnar nerves</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severe </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Involves <strong>both <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> and extensor</strong> muscles. <strong>(Option C ruled out)</strong></li>\n<li>Leads to <strong>severely distorted </strong>contractures with<strong> significant <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> deficits</strong>.</li>\n<li>Long-standing moderate Volkmann contractures can progress to severe forms.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/7bFdzVHJybFLw8ljUd6I1745754765.mp3", "video": ""}, {"text": "A 25-year-old man presents with severe pain and swelling in his forearm after sustaining a crush injury 10 hours ago. He is unresponsive due to sedation, and compartment pressure measurements show 32 mm Hg. What is the next best step in management?", "options": [{"label": "A", "text": "Elevate the arm and monitor pain levels", "correct": false}, {"label": "B", "text": "Perform a volar fasciotomy", "correct": true}, {"label": "C", "text": "Administer anticoagulation therapy", "correct": false}, {"label": "D", "text": "Delay intervention for 24 hours to monitor for improvement", "correct": false}], "correct_answer": "B. Perform a volar fasciotomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/4X9L7yELwvmALXEoobEP1738315256.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8GL3mZAkPpVF8vkyvXgR1743417218.mp3", "video": ""}, {"text": "A 10-year-old boy presents to the clinic with a history of forearm injury that led to Volkmann's ischemic contracture. On examination, the physician notes that the patient has mild flexion deformity of the fingers and some limited movement in the wrist but no significant pain. Which of the following treatment strategies is most appropriate for this patient's condition?", "options": [{"label": "A", "text": "Carpal bone excision", "correct": false}, {"label": "B", "text": "Use of a turn-buckle splint", "correct": true}, {"label": "C", "text": "Maxpage operation", "correct": false}, {"label": "D", "text": "Shortening of forearm bones", "correct": false}], "correct_answer": "B. Use of a turn-buckle splint", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Ut2j0sP19tS4bQoxSVAz1738315388.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:730px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment strategies in an established Volkmann’s Ischemic Contracture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mild Deformities (Tsuge's Type-I)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Use <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> stretching with a<strong> turn-buckle splint</strong> (<strong>Volkmann’s splint</strong>).</li>\n<li>This approach generally yields favorable outcomes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate Deformities</strong> <strong>(Tsuge's Type-II)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Perform a soft tissue sliding operation (<strong>Maxpage operation</strong>). <strong>(Option C ruled out)</strong></li>\n<li>Release the <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> muscles from their origin at the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"9cdc5a92a216927771870d4b257a80\">epicondyle</span> and ulna.</li>\n<li>May also include <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> slides and <span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\">extensor</span> transfer operations.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severe Deformities (Tsuge's Type-III)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Consider bone operations like shortening of <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> bones or <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> bone excision. <strong>(Option A &amp; D ruled out)</strong></li>\n<li>For severe contractures, perform extensive debridement of <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> tissue.</li>\n<li>Follow debridement with <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> transfer procedures to restore motion.</li>\n<li>Transfer the brachioradialis <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> to the <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> pollicis <span class=\"customMeta\" data-dictid=\"7ff574b4f61692777191fa536b5e6c\">longus</span> for thumb movement.</li>\n<li>Transfer the <span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\">extensor</span> carpi <span class=\"customMeta\" data-dictid=\"282d33f842169277719716e285a377\">radialis</span> <span class=\"customMeta\" data-dictid=\"7ff574b4f61692777191fa536b5e6c\">longus</span> to the <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> digitorum <span class=\"customMeta\" data-dictid=\"69427990841692777196166d7a5ec9\">profundus</span> for finger flexion.</li>\n<li>Free muscle <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">transplantation</span> may be needed if the muscle belly is necrosed.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/UWX6KfjzaGvVdiWbMOUO1743417572.mp3", "video": ""}, {"text": "Which of the following statements is false regarding the principles of amputation technique?", "options": [{"label": "A", "text": "Skin flaps should be 1.5 times the limb width", "correct": false}, {"label": "B", "text": "For below-knee amputations, a longer posterior flap is preferred.", "correct": false}, {"label": "C", "text": "A tourniquet is always used, regardless of blood supply.", "correct": true}, {"label": "D", "text": "The fibula is cut 3 cm shorter than the tibia.", "correct": false}], "correct_answer": "C. A tourniquet is always used, regardless of blood supply.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wA3gyo8jDHeCahSTB5Zc1738315481.png", "https://image.prepladder.com/content/umMLeiimJHkGGclJ6BdT1738315534.png", "https://image.prepladder.com/content/Ag6lUIR8Y6bW6szeCRUS1738315565.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Pwl6zKGu8BfhOxIO2zb81743417698.mp3", "video": ""}, {"text": "A 38-year-old man is recovering from a traumatic above-knee amputation. He reports that he sometimes feels as though his leg is still there, and he has episodes of sharp, shooting pain in that area. He also mentions feeling a tingling sensation as if his foot is still present. What condition is the patient experiencing?", "options": [{"label": "A", "text": "Gas Gangrene", "correct": false}, {"label": "B", "text": "Phantom limb sensation and phantom pain", "correct": true}, {"label": "C", "text": "Nerve neuroma", "correct": false}, {"label": "D", "text": "Skin ulceration", "correct": false}], "correct_answer": "B. Phantom limb sensation and phantom pain", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/je7a6DxyJ96XwJ5wrvDw1738315648.png", "https://image.prepladder.com/content/XbVtuZuDemFRNR1N5mEQ1738315691.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/MwYE3hEQ2bbPyoFwD3P11743417851.mp3", "video": ""}, {"text": "Based on the provided X-ray of the foot, identify the types of amputations indicated by labels 1, 2, and 3.", "options": [{"label": "A", "text": "1- Lisfranc, 2- Pirogoff, 3- Chopart", "correct": false}, {"label": "B", "text": "1- Chopart, 2- Lisfranc, 3- Pirogoff", "correct": false}, {"label": "C", "text": "1- Lisfranc, 2- Chopart, 3- Pirogoff", "correct": false}, {"label": "D", "text": "1- Pirogoff, 2- Chopart, 3- Lisfranc", "correct": true}], "correct_answer": "D. 1- Pirogoff, 2- Chopart, 3- Lisfranc", "question_images": ["https://image.prepladder.com/content/zs5fvy4ZviEhsJqnQC1F1738315800.png"], "explanation_images": ["https://image.prepladder.com/content/tO6INj7lhSQoiZCzJB1Q1738315919.png", "https://image.prepladder.com/content/tzwiE3h37A5emI4J0g461738315961.png", "https://image.prepladder.com/content/bo5mQ5F6kk5hdjDYE4wl1738315983.png", "https://image.prepladder.com/content/O1WIBv6fMN5pYzTy2MHT1738316128.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:758px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chopart Amputation</strong></p>\n<ul>\n<li>Amputation through the<strong> mid-tarsal joints.</strong></li>\n<li>Allows for preservation of part of the foot while maintaining some functionality.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Hellerhoff \" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Fran%C3%A7ois_Chopart#/media/File:Fuss_nach_Amputation_in_der_Chopart-Linie_-_Roentgenbild_seitlich.jpg\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/tzwiE3h37A5emI4J0g461738315961.png\" width=\"2984\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lisfranc Amputation</strong></p>\n<ul>\n<li>Amputation through the <strong>tarsometatarsal joints.</strong></li>\n<li>Focuses on removing parts of the <span class=\"customMeta\" data-dictid=\"ca68a3fb831692777203e5f4094b97\">forefoot</span> while attempting to retain as much length as possible.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Sooseong Leem, M. Seung Suk Choi, Jung Woo Chang, Jang Hyun Lee\" data-hash=\"\" data-license=\"CC BY NC\" data-source=\"https://www.jwmr.org/m/journal/view.php?number=12\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/bo5mQ5F6kk5hdjDYE4wl1738315983.png\" width=\"3754\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pirogoff’s Amputation</strong></p>\n<ul>\n<li>Involves <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> of the back of the os calcis to the cut ends of the <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> and fibula.</li>\n<li>Only the<strong> <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> part of the calcaneum</strong> is removed.</li>\n<li>Parts removed are\n\t\t\t\t<ul>\n<li>Forefoot</li>\n<li>Midfoot</li>\n<li>Talus</li>\n<li>Distal part of calcaneus</li>\n<li>Distal <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> cartilage</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Abdul Aziz Mohd Nather, Jun Kong, M. Y. Hasan, A. Nambiar \" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.semanticscholar.org/paper/Results-of-the-modified-Pirogoff-amputation-with-Nather-Kong/716ffcf719a674b466d4382eec03a7c430bdaa56/figure/1\" data-tags=\"\" height=\"600\" src=\"https://image.prepladder.com/content/O1WIBv6fMN5pYzTy2MHT1738316128.png\" width=\"1195\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/eRvC1xq57Kcx6Ltc2LZ71743417971.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 24 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 10</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Complications Of Fractures-Previous Year Questions - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 10</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 10 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Identify the amputation shown in the image below.", "options": [{"label": "A", "text": "Above knee amputation", "correct": false}, {"label": "B", "text": "Below knee amputation", "correct": true}, {"label": "C", "text": "Above elbow amputation", "correct": false}, {"label": "D", "text": "Syme's amputation", "correct": false}], "correct_answer": "B. Below knee amputation", "question_images": ["https://image.prepladder.com/content/PXOK4v86bwrdr4SgVwTp1724908876.png"], "explanation_images": ["https://image.prepladder.com/content/kZOpOEsF5yDdOFPiciyo1748208095.png", "https://image.prepladder.com/content/ftQhBD5mUQppFAOyH7Y41748208064.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type of Amputation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Description</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Indications</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Functionality and <span class=\"customMeta\" data-dictid=\"17d0626681169277719604432b4d27\">Prosthesis</span> Considerations</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Partial Foot Amputation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves the removal of part of the foot, including toes or part of the forefoot.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe trauma</li>\n<li>Diabetes-related complications (e.g., gangrene)</li>\n<li>Infection</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Retains some function of the foot for walking</li>\n<li>Custom <span class=\"customMeta\" data-dictid=\"ec2e1aa63016927771966c31cba210\">prostheses</span> for toes and forefoot</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transmetatarsal <span class=\"customMeta\" data-dictid=\"9dfe4d42641692777181673eb73924\">Amputation</span> (TMA)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Amputation through the <span class=\"customMeta\" data-dictid=\"b7f1b05b6d1692777192a18bc2396f\">metatarsal</span> bones, removing the <span class=\"customMeta\" data-dictid=\"ca68a3fb831692777203e5f4094b97\">forefoot</span> but leaving the <span class=\"customMeta\" data-dictid=\"0d16a0be9416927771923ac3d80676\">midfoot</span> and <span class=\"customMeta\" data-dictid=\"985099b0c21692777189e60ac33141\">hindfoot</span> intact.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe foot injury</li>\n<li>Diabetes-related complications</li>\n<li>Gangrene or infection</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Often requires a <span class=\"customMeta\" data-dictid=\"17d0626681169277719604432b4d27\">prosthesis</span> that fits the <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> part of the foot for better weight-bearing</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lisfranc Amputation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Removal of the forefoot, including the toes and <span class=\"customMeta\" data-dictid=\"b7f1b05b6d1692777192a18bc2396f\">metatarsal</span> bones, but preserving the <span class=\"customMeta\" data-dictid=\"985099b0c21692777189e60ac33141\">hindfoot</span> and ankle.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"336\" src=\"https://image.prepladder.com/content/kZOpOEsF5yDdOFPiciyo1748208095.png\" width=\"223\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe trauma</li>\n<li>Chronic infection</li>\n<li>Vascular disease</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prosthetic options are complex due to the loss of the midfoot</li>\n<li>Often uses a custom device</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Syme’s <span class=\"customMeta\" data-dictid=\"9dfe4d42641692777181673eb73924\">Amputation</span> <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Removal of the foot at the ankle joint, with the <span class=\"customMeta\" data-dictid=\"0f66ada5d616927771898f530a8510\">heel pad</span> being preserved.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"442\" src=\"https://image.prepladder.com/content/ftQhBD5mUQppFAOyH7Y41748208064.png\" width=\"335\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Trauma</li>\n<li>Severe infections</li>\n<li>Vascular disease (e.g., gangrene)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Functional <span class=\"customMeta\" data-dictid=\"17d0626681169277719604432b4d27\">prosthesis</span> can be used, providing near-normal walking function</li>\n<li>Heel pad aids in load-bearing</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transtibial <span class=\"customMeta\" data-dictid=\"9dfe4d42641692777181673eb73924\">Amputation</span> (Below-Knee)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Amputation below the knee joint, typically through the <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> and fibula.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe trauma</li>\n<li>Peripheral <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> disease</li>\n<li>Diabetes complications</li>\n<li>Tumors</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Functional <span class=\"customMeta\" data-dictid=\"ec2e1aa63016927771966c31cba210\">prostheses</span> (below-knee prosthesis) with ankle and foot components</li>\n<li>Retains knee function</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Knee Disarticulation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Amputation through the knee joint, preserving the <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> while removing the <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> and fibula.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe trauma</li>\n<li>Infection</li>\n<li>Vascular disease</li>\n<li>Bone cancer</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prosthetic knee and foot required</li>\n<li>Retains better <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> limb length for <span class=\"customMeta\" data-dictid=\"17d0626681169277719604432b4d27\">prosthesis</span> fitting</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transfemoral <span class=\"customMeta\" data-dictid=\"9dfe4d42641692777181673eb73924\">Amputation</span> (Above-Knee) <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Amputation above the knee joint, through the femur.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe trauma</li>\n<li>Cancer</li>\n<li>Chronic infection</li>\n<li>Peripheral <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> disease</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Requires a <span class=\"customMeta\" data-dictid=\"17d0626681169277719604432b4d27\">prosthesis</span> with both knee and ankle components</li>\n<li>More energy is required for walking</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hip Disarticulation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Removal of the entire leg at the hip joint, including the femur.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe trauma</li>\n<li>Tumors</li>\n<li>Vascular disease</li>\n<li>Severe infection</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prosthetic limb involves the hip joint, requires specialized sockets and joints for movement</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A motorcyclist met with a road traffic accident and had a metacarpal fracture. Hypothenar atrophy is observed. Identify the nerve involved.", "options": [{"label": "A", "text": "Radial nerve", "correct": false}, {"label": "B", "text": "Ulnar nerve", "correct": true}, {"label": "C", "text": "Musculocutaneous nerve", "correct": false}, {"label": "D", "text": "Median nerve", "correct": false}], "correct_answer": "B. Ulnar nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/CoZJl4GxLAdS46AUz6ed1747826851.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old patient presents with limping gait and left hip pain. What is the likely diagnosis?", "options": [{"label": "A", "text": "Tuberculosis of the hip", "correct": false}, {"label": "B", "text": "Rheumatoid arthritis", "correct": false}, {"label": "C", "text": "Ankylosing spondylitis", "correct": false}, {"label": "D", "text": "Avascular necrosis", "correct": true}], "correct_answer": "D. Avascular necrosis", "question_images": ["https://image.prepladder.com/notes/U3rDdg3NIZKXaBYPTTNJ1745329643.jpg"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the subsequent observations manifest itself later in compartment syndrome?", "options": [{"label": "A", "text": "Pallor", "correct": false}, {"label": "B", "text": "Paralysis", "correct": true}, {"label": "C", "text": "Pulselessness", "correct": false}, {"label": "D", "text": "Pain on passive stretch", "correct": false}], "correct_answer": "B. Paralysis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "As the intern on duty, your responsibility includes attending to patients involved in a road traffic accident. Identify the patient from the options below for whom you would promptly contact the orthopaedic resident on call.", "options": [{"label": "A", "text": "Patient with recurrent shoulder dislocation", "correct": false}, {"label": "B", "text": "Patient with a fractured arm with capillary refill time of less than 3 seconds in his fingers", "correct": false}, {"label": "C", "text": "Patient with a fractured arm with a 10 cm long incision over the arm", "correct": false}, {"label": "D", "text": "Patient with a fractured arm with capillary refill time of 5 seconds in his fingers", "correct": true}], "correct_answer": "D. Patient with a fractured arm with capillary refill time of 5 seconds in his fingers", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 79 yrs old lady had a fall in the bathroom, the following X-rays were taken in order to make a diagnosis. Which of the following is treatment of this condition?", "options": [{"label": "A", "text": "Hemiarthroplasty", "correct": true}, {"label": "B", "text": "Hip spica", "correct": false}, {"label": "C", "text": "Total Hip Replacement", "correct": false}, {"label": "D", "text": "Nailing", "correct": false}], "correct_answer": "A. Hemiarthroplasty", "question_images": ["https://image.prepladder.com/content/f8vyA9zlu2eV3nmCOYDo1746706625.png"], "explanation_images": ["https://image.prepladder.com/content/80nmylkdlsgDQmmmDJsG1746706656.png", "https://image.prepladder.com/content/nRVmSL25F9KFZIHHlgUP1746706657.png", "https://image.prepladder.com/content/fdHcnfc77xRbcA2HrNkH1746706657.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:618px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Low-Energy Trauma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common in elderly with <strong>osteoporosis</strong>; simple fall from <span class=\"customMeta\" data-dictid=\"f428f17ce1169277719924aafd0e51\">standing height</span> can cause a fracture.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Osteoporosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Age-related bone loss; post-menopausal women at higher risk; fractures occur with minimal trauma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathological Fractures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Caused by conditions like metastatic bone disease, multiple myeloma, or Paget’s disease; minimal force needed for fracture.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stress Fractures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Seen in athletes or military personnel due to repetitive stress.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Groin pain radiating to <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> thigh or knee; sharp pain worsened by movement.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inability to Bear Weight</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unable to stand or walk due to pain, less severe in stress fractures.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Attitude of affected limb</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Shortened and externally rotated limb in displaced fractures; limited internal <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> and flexion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bruising and Swelling</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Minimal <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> due to deep <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> neck location; sometimes bruising around hip or groin.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>X-ray (AP and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> views) is the primary modality; fractures are classified using the Garden classification.</p>\n<p> </p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Rohan Bhimani \" data-hash=\"\" data-license=\"CC BY-SA \" data-source=\"https://www.wikidoc.org/index.php/File:Xray_Femoral_neck_fracture.gif\" data-tags=\"\" height=\"392\" src=\"https://image.prepladder.com/content/80nmylkdlsgDQmmmDJsG1746706656.png\" width=\"272\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment Options</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Non-displaced:</strong> Internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> (e.g., cannulated screws)</li>\n<li><strong>Displaced:</strong> Surgical <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> (<strong>hemiarthroplasty</strong>, total hip replacement)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High risk of <span class=\"customMeta\" data-dictid=\"52a1dd8c4f1692777193dd58a0d51c\">nonunion</span> and <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> necrosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"371\" src=\"https://image.prepladder.com/content/nRVmSL25F9KFZIHHlgUP1746706657.png\" width=\"371\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:720px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Garden’s <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">classification</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Treatment in adults </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Treatment in children </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Garden’s type 1</strong></p>\n<p>(incomplete, impacted, or abducted fracture)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Conservative methods</li>\n<li>Immobilization in a Thomas <span class=\"customMeta\" data-dictid=\"7f606f911b1692777199eb69ab67c5\">splint</span> with traction</li>\n<li>Internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> with screws (if <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> is feared)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hip <span class=\"customMeta\" data-dictid=\"f2ad4340681692777199d8bf0f5cbb\">spica</span> <strong>(Option B ruled out)</strong></li>\n<li>Traction is applied through a pin (Moore’s pin) or wire in older adolescents</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Garden’s type 2</strong></p>\n<p>(complete but undisplaced)</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> with cannulated screws, dynamic hip screws, <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> locking plates, and cephalomedullary nails.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Garden’s <span class=\"customMeta\" data-dictid=\"6f809a27121692777201d1ccde5ace\">type 3</span> </strong></p>\n<p>(complete &amp; partially displaced)<strong> </strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Hemiarthroplasty </strong>(done in inactive elderly of &gt;60years of age with comorbidities)</li>\n<li>Total hip <span class=\"customMeta\" data-dictid=\"54ac01f4f116927771829dd4d10428\">arthroplasty</span> (done in active older patients)</li>\n<li>Internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> (done in young adults)</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> (using Knowle’s screw)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Garden’s type 4</strong></p>\n<p>(complete &amp; fully displaced)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "As the intern on duty, your responsibility includes attending to patients involved in a road traffic accident. Identify the patient from the options below for whom you would promptly contact the orthopaedic resident on call.", "options": [{"label": "A", "text": "Patient with recurrent shoulder dislocation", "correct": false}, {"label": "B", "text": "Patient with a fractured arm with capillary refill time of less than 3 seconds in his fingers", "correct": false}, {"label": "C", "text": "Patient with a fractured arm with intact skin and minimal swelling.", "correct": false}, {"label": "D", "text": "Patient with a fractured arm with capillary refill time of 5 seconds in his fingers", "correct": true}], "correct_answer": "D. Patient with a fractured arm with capillary refill time of 5 seconds in his fingers", "question_images": [], "explanation_images": [], "explanation": "<table>\n<thead>\n<tr>\n<th><strong>Parameter</strong></th>\n<th><strong>Critical Concern</strong></th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Capillary refill time</td>\n<td>&gt; 2 seconds = <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> compromise</td>\n</tr>\n<tr>\n<td>Limb color and temperature</td>\n<td>Pallor/coldness = poor perfusion</td>\n</tr>\n<tr>\n<td>Pulse examination</td>\n<td>Absent/diminished <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> pulses = arterial injury</td>\n</tr>\n<tr>\n<td>Skin status</td>\n<td>Open wounds = open <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> → risk of infection</td>\n</tr>\n<tr>\n<td>Pain disproportionate to injury</td>\n<td>Suspect <strong>compartment syndrome</strong></td>\n</tr>\n<tr>\n<td>Neurological status</td>\n<td>Paresthesia, motor weakness = possible nerve injury</td>\n</tr>\n<tr>\n<td>Swelling or <span class=\"customMeta\" data-dictid=\"12f7e36ffd16927772000cb2186249\">tense</span> compartments</td>\n<td>Consider <strong>fasciotomy</strong> if <span class=\"customMeta\" data-dictid=\"ce3edddb5116927771844c030f3c1e\">compartment</span> pressure is high</td>\n</tr>\n</tbody>\n</table>\n<table>\n<thead>\n<tr>\n<th><strong>Category</strong></th>\n<th><strong>Examples</strong></th>\n<th><strong>Urgency</strong></th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Open fractures</strong></td>\n<td>Bone exposed or wound &gt;1 cm over <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> site</td>\n<td>Emergency <span class=\"customMeta\" data-dictid=\"66beddba7f169277719425c6d55e69\">ortho</span> consult</td>\n</tr>\n<tr>\n<td><strong>Vascular compromise</strong></td>\n<td>Absent pulses, CRT &gt;2 sec, cold limb</td>\n<td>Emergency <span class=\"customMeta\" data-dictid=\"66beddba7f169277719425c6d55e69\">ortho</span> + vascular</td>\n</tr>\n<tr>\n<td><strong>Compartment syndrome</strong></td>\n<td>Pain out of proportion, paresthesia, pallor, pulselessness, paralysis</td>\n<td>Fasciotomy indicated</td>\n</tr>\n<tr>\n<td><strong>Joint dislocations</strong></td>\n<td>Shoulder, knee, hip dislocations</td>\n<td>Urgent (but not always emergency)</td>\n</tr>\n<tr>\n<td><strong>Spinal trauma</strong></td>\n<td>Neurological deficits, high-impact injury</td>\n<td>Immobilize + MRI/CT</td>\n</tr>\n<tr>\n<td><strong>Pelvic fractures</strong></td>\n<td>Risk of hemorrhagic shock</td>\n<td>Emergency trauma care</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For hypertrophic non-union following a fracture, the most appropriate treatment", "options": [{"label": "A", "text": "Stabilization", "correct": true}, {"label": "B", "text": "Bone grafting", "correct": false}, {"label": "C", "text": "Stabilization and bone grafting", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Stabilization", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A: S\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the earliest indication of acute compartment syndrome?", "options": [{"label": "A", "text": "Pain", "correct": true}, {"label": "B", "text": "Pallor", "correct": false}, {"label": "C", "text": "Paresthesia", "correct": false}, {"label": "D", "text": "Paralysis", "correct": false}], "correct_answer": "A. Pain", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the following marked structures.", "options": [{"label": "A", "text": "1 - Sequestrum, 2 - Involucrum, 3 - Cloacae", "correct": false}, {"label": "B", "text": "1 - Sequestrum, 2 - Cloacae, 3 - Involucrum", "correct": false}, {"label": "C", "text": "1 - Involucrum, 2 - Cloacae, 3 - Sequestrum", "correct": true}, {"label": "D", "text": "1- Cloacae, 2 Involucrum - Sequestrum, 3", "correct": false}], "correct_answer": "C. 1 - Involucrum, 2 - Cloacae, 3 - Sequestrum", "question_images": ["https://image.prepladder.com/content/uS4S5lgtlhXbzv2CK70X1691489764.png"], "explanation_images": ["https://image.prepladder.com/content/ABNjdYnz3J33wIljr64t1695620310.png", "https://image.prepladder.com/content/hZVhSAgItnVfrt8oN8cI1695620319.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 20 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 21</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">General-Miscellaneous Topics In Orthopedics - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 21</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 21 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 45-year-old man is being evaluated for fracture union 8 weeks after sustaining a tibial shaft fracture. Which of the following is NOT a clinical sign of fracture union?", "options": [{"label": "A", "text": "Ability to bear weights", "correct": false}, {"label": "B", "text": "Presence of tenderness at the fracture site", "correct": true}, {"label": "C", "text": "Absence of free movement between the fractured fragments", "correct": false}, {"label": "D", "text": "Visible callus bridging the fractured site on X-ray", "correct": false}], "correct_answer": "B. Presence of tenderness at the fracture site", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zEdWozKqWGhPwHiNVGsX1738220880.jpg"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:726px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Clinical Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Radiological Signs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<ul>\n<li>Absence of free movement between the fractured fragments <strong>(Option C)</strong></li>\n<li>Absence of <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> at the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> site</li>\n<li>No pain/tenderness on palpation/examination</li>\n<li>Ability to bear weight <strong>(Option A)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<ul>\n<li>Visible <span class=\"customMeta\" data-dictid=\"e9321290da16927771830865e0eb6e\">callus</span> <span class=\"customMeta\" data-dictid=\"ec4db08de51692777183e82739c83d\">bridging</span> the fractured site and connecting the fractured fragments<strong> (Option D)</strong></li>\n<li>Continuity of bone <span class=\"customMeta\" data-dictid=\"ecfec60ca61692777200dd3d86cd90\">trabeculae</span> across the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> - <span class=\"customMeta\" data-dictid=\"ec4db08de51692777183e82739c83d\">Bridging</span> callus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #808080; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #808080; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/zEdWozKqWGhPwHiNVGsX1738220880.jpg\" width=\"500\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/HuJcYxUE3DBiHoJnS0Jd1742907822.mp3", "video": ""}, {"text": "A 35-year-old male presents to the emergency department following a motorcycle accident. Upon examination, he has severe pelvic pain and is unable to bear weight. Radiographic imaging reveals a complete disruption of the posterior pelvic arch, with associated sacral fractures and displacement. Based on the findings, which type of pelvic fracture classification does this injury belong to?", "options": [{"label": "A", "text": "Type A", "correct": false}, {"label": "B", "text": "Type B", "correct": false}, {"label": "C", "text": "Type C", "correct": true}, {"label": "D", "text": "Type D", "correct": false}], "correct_answer": "C. Type C", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/31RoJ7gNetZBxZERYilx1744215420.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:670px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Tiles <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> of <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">Pelvic</span> Fractures</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Stability</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Subtype</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>A</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Stable </strong>(posterior <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> intact)</p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>A1: <span class=\"customMeta\" data-dictid=\"954dd74f031692777182664659765f\">Avulsion</span> injury</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>A2: Iliac-wing or anterior-arch <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> due to a direct blow</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>A3: <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">Transverse</span> <span class=\"customMeta\" data-dictid=\"c5e0f80e7e1692777198edc686a232\">sacrococcygeal</span> fracture</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>B</strong></p>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Partially stable</strong> (incomplete <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> of the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> arch)</p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>B1: Open-book injury (external rotation)</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>B2: Lateral-compression injury (internal rotation)</p>\n<ul>\n<li>B2-1: <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">Ipsilateral</span> <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> injuries</li>\n<li>B2-2: <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">Contralateral</span> (bucket-handle) injuries</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>B3: Bilateral</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>C</strong></p>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Unstable</strong></p>\n<p>(complete <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> of the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> arch)</p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>C1: Unilateral</p>\n<ul>\n<li>C1-1: <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">Iliac</span> fracture</li>\n<li>C1-2: <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">Sacroiliac</span> fracture-dislocation</li>\n<li>C1-3: Sacral fracture</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>C2: Bilateral, with one side type B, one side type C</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>C3: Bilateral</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8nBBaxkce0DiEHFtAVMo1742920732.mp3", "video": ""}, {"text": "A 45-year-old male presents with progressive knee pain, swelling, reduced range of motion, and occasional mechanical locking. An X-ray of the knee is given below. MRI confirms the presence of lobular cartilage nodules with areas of calcification. What is the most appropriate treatment for this patient?", "options": [{"label": "A", "text": "Observation and conservative management", "correct": false}, {"label": "B", "text": "Arthroscopic synovectomy and loose body removal", "correct": true}, {"label": "C", "text": "Total knee replacement", "correct": false}, {"label": "D", "text": "Physical therapy only", "correct": false}], "correct_answer": "B. Arthroscopic synovectomy and loose body removal", "question_images": ["https://image.prepladder.com/content/D5QtbAagJ44FZzDOfu4W1738222269.png"], "explanation_images": ["https://image.prepladder.com/content/RrN97EWL7e1QW4Ia3QGO1738222365.png", "https://image.prepladder.com/content/RYE61hPQAM8rB1CcPWG11738222546.png", "https://image.prepladder.com/notes/7uHoDVfhGcJfQtastOpU1744215622.png", "https://image.prepladder.com/content/LxZEg6Fti2zCehGG3aDc1738222472.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/rXFe2utOz2fk56QIhgNX1742920559.mp3", "video": ""}, {"text": "A 45-year-old male presents with progressive knee pain and swelling over the past few months. He reports occasional mechanical locking during movement and a reduced range of motion. Physical examination reveals mild joint swelling, crepitus, and limited knee flexion. An X-ray shows multiple calcified loose bodies within the joint space but no apparent synovial involvement. Based on the Milgram Classification, which stage does this patient’s condition most likely fall into?", "options": [{"label": "A", "text": "Early stage (Class I)", "correct": false}, {"label": "B", "text": "Intermediate stage (Class II)", "correct": false}, {"label": "C", "text": "Final stage (Class III)", "correct": true}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "C. Final stage (Class III)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/95aCGBSH7OeLgswMfYwb1742920374.mp3", "video": ""}, {"text": "A 7-year-old child is brought to the clinic after a routine physical examination reveals shoulder abnormalities like in the given image. The child is otherwise healthy and shows no significant discomfort. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Sprengel’s Deformity", "correct": false}, {"label": "B", "text": "Klippel–Feil Syndrome", "correct": false}, {"label": "C", "text": "Madelung's Deformity", "correct": false}, {"label": "D", "text": "Cleidocranial Dysostosis", "correct": true}], "correct_answer": "D. Cleidocranial Dysostosis", "question_images": ["https://image.prepladder.com/notes/EUqojxeyBPfuG03mcQaY1744215934.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/WJMMQ12EeGtypJMMSTaj1745691239.mp3", "video": ""}, {"text": "A 35-year-old male presents to the emergency department after a motor vehicle accident where his forehead struck the steering wheel. He complains of neck pain but no neurological deficits. Imaging reveals a fracture of the pars interarticularis of C2 with anterior displacement of the vertebra. There is 4 mm of subluxation at the C2/3 level. What is the most appropriate management for this patient?", "options": [{"label": "A", "text": "Rigid cervical collar", "correct": false}, {"label": "B", "text": "Halo fixation for 6 to 12 weeks", "correct": true}, {"label": "C", "text": "Immediate surgical intervention", "correct": false}, {"label": "D", "text": "Conservative management with analgesics and observation", "correct": false}], "correct_answer": "B. Halo fixation for 6 to 12 weeks", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:679px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Levine &amp; Edward Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 1</strong>: Less than 3 mm subluxation, stable</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rigid <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> collar <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 2</strong>: Greater than 4 mm subluxation, unstable</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-Less than 5 mm - Reduction in <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> and <span class=\"customMeta\" data-dictid=\"95af91681416927771887742113c38\">halo</span> <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> for 6 to 12 weeks</p>\n<p>-Greater than 5 mm - Require surgery <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 2a</strong>: Unstable with <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> injury and <span class=\"customMeta\" data-dictid=\"777420204116927771812106969c5e\">angular</span> deformity</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Halo fixation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 3</strong>: Unstable with <span class=\"customMeta\" data-dictid=\"25d29169e3169277720246b37b93ef\">facet</span> and <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"7ba18aa5e616927771918a45051a40\">longitudinal</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> disruption</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Require surgery <strong>(Option C)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ATSGbhnfYNl0UL1shNtZ1742912001.mp3", "video": ""}, {"text": "A 35-year-old male is brought to the emergency department after a high-impact motorcycle accident. He presents with significant swelling and bruising in the lower abdomen and thighs. During the examination, he exhibits tenderness upon palpation of the abdomen. Pelvic compression test is positive. The patient is unable to void, and the bladder is not palpable. What is the most appropriate initial management step for this patient?", "options": [{"label": "A", "text": "Immediate surgery for internal fixation", "correct": false}, {"label": "B", "text": "Apply pelvic binders and initiate resuscitation", "correct": true}, {"label": "C", "text": "Order a CT scan of the pelvis", "correct": false}, {"label": "D", "text": "Initiate strict bed rest and monitor vital signs", "correct": false}], "correct_answer": "B. Apply pelvic binders and initiate resuscitation", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Mb5ZvvhevmAOQXm3hTxp1738221737.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/WJtWbZ0aHuocEbImevsO1742911396.mp3", "video": ""}, {"text": "Which of the following ligaments provide stability to the pelvis?", "options": [{"label": "A", "text": "Sacro-iliac ligament", "correct": false}, {"label": "B", "text": "Ilio-lumbar ligament", "correct": false}, {"label": "C", "text": "Superior pubic ligament", "correct": false}, {"label": "D", "text": "All of the above", "correct": true}], "correct_answer": "D. All of the above", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Q1nDr5m4UUCFVlKFQiu61738221576.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ZLZxsC7MeApy00CoIPkt1742910961.mp3", "video": ""}, {"text": "A newborn presents with weakness in the left arm. On examination, the infant's hand shows a claw-like deformity like shown in the image below. Which of the following statements is most likely true regarding this condition?", "options": [{"label": "A", "text": "It involves injury to the C5-C6 nerve roots", "correct": false}, {"label": "B", "text": "The arm will present in a \"waiter's tip\" posture", "correct": false}, {"label": "C", "text": "It is more common than injuries affecting the upper brachial plexus", "correct": false}, {"label": "D", "text": "It is caused by damage to the C8-T1 nerve roots", "correct": true}], "correct_answer": "D. It is caused by damage to the C8-T1 nerve roots", "question_images": ["https://image.prepladder.com/content/BJNcOVE4w79c1MZuKldC1738221395.png"], "explanation_images": ["https://image.prepladder.com/content/ToADS2TBEyIEVVflEIHQ1738221492.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:670px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Erb's Palsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Klumpke's Palsy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Affected Nerve Roots</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>C5-C6 roots <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>C8-T1 roots</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristic Posture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Waiter's tip posture<strong> (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Claw hand deformity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arm Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Internally rotated and adducted arm</li>\n<li>Extended and pronated forearm</li>\n<li>Flexed wrist</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>MCP joints extended</li>\n<li>Interphalangeal joints are flexed</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Frequency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common<strong> (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/rPUj29XnVS83Psjuv0061742117378.mp3", "video": ""}, {"text": "A 1-month-old infant presents with weakness in the right arm, inability to abduct the shoulder or flex the elbow, and the arm is held in internal rotation with the forearm pronated. An image of the infant is given below. Which of the following sequences best represents the appropriate management approach?", "options": [{"label": "A", "text": "MRI, observation for 6 months, surgical intervention if no improvement at 6 months", "correct": false}, {"label": "B", "text": "EMG, botulinum toxin injections, reassess at 1 year", "correct": false}, {"label": "C", "text": "X-ray, observation for 6 months, nerve graft surgery", "correct": false}, {"label": "D", "text": "MRI, early physiotherapy and hydrotherapy, reassess for surgical intervention if no improvement by 3-6 months", "correct": true}], "correct_answer": "D. MRI, early physiotherapy and hydrotherapy, reassess for surgical intervention if no improvement by 3-6 months", "question_images": ["https://image.prepladder.com/content/KzpiLVy8DsWVgFJpWSUJ1748019059.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:673px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Clinical diagnosis based on history and physical examination</li>\n<li>MRI of <span class=\"customMeta\" data-dictid=\"1e4db8b6ad1692777183683f42d44b\">brachial</span> <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> and <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> cord <strong>(best <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> technique)</strong></li>\n<li>X-ray to exclude fractures</li>\n<li>Electromyography (EMG) to assess muscle electrical activity</li>\n<li>Nerve <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> studies (NCS) to measure nerve signal transmission</li>\n<li>CT <span class=\"customMeta\" data-dictid=\"67889d70a11692777193d1c6ed65f7\">myelography</span> for detailed <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> of <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord and nerve roots</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Conservative management done in most cases</li>\n<li>Early <span class=\"customMeta\" data-dictid=\"3024d9916e16927771896f5b7159b6\">immobilization</span> followed by <span class=\"customMeta\" data-dictid=\"069cba94231692777197b41e753795\">range of motion</span> exercises</li>\n<li><strong>Hydrotherapy:</strong> Anti-gravity environment for muscle strengthening</li>\n<li><strong>Physiotherapy:</strong> Stretching, <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> stimulation, <span class=\"customMeta\" data-dictid=\"069cba94231692777197b41e753795\">range of motion</span> exercises</li>\n<li><strong>Occupational therapy: </strong>For long-term cases to assist with daily activities</li>\n<li><strong>Surgical intervention: </strong>Considered if no functional recovery with conservative management\n\t\t\t\t<ul>\n<li>Nerve graft</li>\n<li>Nerve decompression</li>\n</ul>\n</li>\n<li><strong>Medical therapy:</strong> Botulinum <span class=\"customMeta\" data-dictid=\"41329dc9381692777200a9b6d57cf4\">toxin</span> injections for <span class=\"customMeta\" data-dictid=\"3c13e3c8e91692777185822d4393f9\">contracture</span> relief</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Generally favorable if treated early</li>\n<li>About 90% of infants show recovery with time</li>\n<li>10% may continue to have a dysfunctional arm</li>\n<li>Neglected cases may lead to 20-30% permanent deficit of nerve function</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/BIl6g1jhgK5eqKkk1N511742908605.mp3", "video": ""}, {"text": "A newborn presents with weakness in the right arm, inability to abduct the shoulder or flex the elbow, and the arm is held in internal rotation with the forearm pronated. Which of the following best describes the pathophysiology of this condition?", "options": [{"label": "A", "text": "Injury to the lower trunk of the brachial plexus (C8-T1)", "correct": false}, {"label": "B", "text": "Compression of the median nerve at the carpal tunnel", "correct": false}, {"label": "C", "text": "Injury to the upper trunk of the brachial plexus (C5-C6)", "correct": true}, {"label": "D", "text": "Avulsion of the cervical nerve roots from the spinal cord", "correct": false}], "correct_answer": "C. Injury to the upper trunk of the brachial plexus (C5-C6)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/eTB4MMpWV5EnNbOqUNYM1738221107.png", "https://image.prepladder.com/content/IxcTzmzWmcJdGiuOvCw01738221033.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:719px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Injury to the upper trunk of the <span class=\"customMeta\" data-dictid=\"1e4db8b6ad1692777183683f42d44b\">brachial</span> <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> (C5-C6)</li>\n<li>Most commonly caused by <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> of the neck during delivery</li>\n<li>Severity ranges from <span class=\"customMeta\" data-dictid=\"495fbdcda11692777193c0969ff0b4\">neuropraxia</span> (least severe) to <span class=\"customMeta\" data-dictid=\"05ae605eb81692777193359fdca623\">neurotmesis</span> (most severe)</li>\n<li>Can involve C7 in more severe cases (Extended Erb's Palsy)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Weakness of the arm</li>\n<li>Loss of sensation in the arm</li>\n<li>Paralysis and <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> of deltoid, biceps, and brachialis muscles</li>\n<li>Limited shoulder abduction- Deltoid, Supraspinatus</li>\n<li>Inability to <span class=\"customMeta\" data-dictid=\"73eb6a06aa1692777202a9f27fafa2\">flex</span> the elbow- <span class=\"customMeta\" data-dictid=\"6b395fd7b21692777183cf78e12920\">Biceps</span> brachii, Brachialis</li>\n<li>Internal <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> and <span class=\"customMeta\" data-dictid=\"189ee8a22a1692777196b04278555f\">pronation</span> of the arm- Subscapularis, <span class=\"customMeta\" data-dictid=\"51d02ec7e5169277719693f472fa48\">Pronator</span> teres, <span class=\"customMeta\" data-dictid=\"afa97794e21692777195a324ffec49\">Pectoralis</span> major.</li>\n<li>\"Waiter's tip\" posture</li>\n<li>Absent <span class=\"customMeta\" data-dictid=\"b11a00724a1692777192f3ade06858\">Moro reflex</span> on the affected side</li>\n<li>Present grasp reflex</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/sQm9BURTQzodEw5EnnpL1742908160.mp3", "video": ""}, {"text": "A 7-year-old girl presents with an elevated left scapula that is noticeably higher than the right, a shorter neck appearance as shown in the image below, and painless shoulder movements, although there is some limitation in abduction. The mother reports that this condition was apparent at birth. Which of the following conditions is most likely the diagnosis?", "options": [{"label": "A", "text": "Klippel–Feil syndrome", "correct": false}, {"label": "B", "text": "Madelung's deformity", "correct": false}, {"label": "C", "text": "Cleidocranial dysostosis", "correct": false}, {"label": "D", "text": "Sprengel's deformity", "correct": true}], "correct_answer": "D. Sprengel's deformity", "question_images": ["https://image.prepladder.com/content/5MEayfMHbEi5mHqy1hzH1738045438.png"], "explanation_images": ["https://image.prepladder.com/content/2RnceeXuFBc1hv9sT4ea1738045639.png", "https://image.prepladder.com/content/k6YqktL2UsDiuw4fLOeo1738045833.png", "https://image.prepladder.com/content/z9X5iHlSALa9qeNpA5Oi1738045948.png", "https://image.prepladder.com/content/sfklzaFAtpVstUeQUC1Z1738046027.png", "https://image.prepladder.com/content/2QJbZ5GHsTRkNQ2jHxJX1738046329.png", "https://image.prepladder.com/content/TlNNCQpAR5UL7bB1rpmY1738046155.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/wmYHM4sKVvY1gZyHTS121742048108.mp3", "video": ""}, {"text": "Regarding fracture healing, which of the following statements is INCORRECT?", "options": [{"label": "A", "text": "Children's fractures heal faster than adults", "correct": false}, {"label": "B", "text": "Spiral fractures unite more slowly than oblique fractures", "correct": true}, {"label": "C", "text": "Cancellous bones unite faster than cortical bones", "correct": false}, {"label": "D", "text": "Open fractures are prone to delayed union", "correct": false}], "correct_answer": "B. Spiral fractures unite more slowly than oblique fractures", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:600px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Faster Healing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Slower Healing</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Age</strong>: Fractures unite faster in children than in adults <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Fracture Type</strong>: Open fractures and <span class=\"customMeta\" data-dictid=\"9c8512bb5d169277718470669bd36e\">comminuted</span> fractures often go into delayed union and non-union <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Bone Type: Flat <span class=\"customMeta\" data-dictid=\"5f96e2a37016927771834373e8902b\">cancellous</span> bones unite faster than <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> bones <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Bone Diseases</strong>: <span class=\"customMeta\" data-dictid=\"4c8be6d6b716927771948551f98378\">Osteoporosis</span> and bone infection delay <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> healing</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Fracture Pattern:</strong> <span class=\"customMeta\" data-dictid=\"0b34a9891d16927771998a84595013\">Spiral</span> fractures unite faster than <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> fractures, which unite faster than <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> fractures</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Nutrition</strong>: Poor <span class=\"customMeta\" data-dictid=\"05bef24e711692777193a154b462b4\">nutrition</span> can hinder <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> healing</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Reduction</strong>: Good <span class=\"customMeta\" data-dictid=\"7339502e9916927771815edcf9dc99\">apposition</span> of <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> results in faster union</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Poor circulation</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/YGJ1HzPVdDgiNqICynwF1742907557.mp3", "video": ""}, {"text": "Regarding the Ilizarov technique for distraction osteogenesis, which of the following statements is INCORRECT?", "options": [{"label": "A", "text": "The technique involves the use of a ring fixator that stabilizes the limb and allows for controlled distraction or compression.", "correct": false}, {"label": "B", "text": "Distraction osteogenesis requires a dynamic state where the site of osteogenesis undergoes either controlled distraction or controlled compression.", "correct": false}, {"label": "C", "text": "The rate of distraction or compression is typically carried out at 1 mm per day, done in four sittings of 0.25 mm each.", "correct": false}, {"label": "D", "text": "The Ilizarov technique is ineffective in correcting deformities or treating non-unions.", "correct": true}], "correct_answer": "D. The Ilizarov technique is ineffective in correcting deformities or treating non-unions.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/4Mm3ZBzNF87wEE8fFTmd1738220664.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/iHBrUTgJ4ZYrspOIXUVB1742907370.mp3", "video": ""}, {"text": "Identify the correct sequence of the mentioned stages of fracture healing", "options": [{"label": "A", "text": "Inflammation, Callus formation, Remodeling, Hematoma formation, Modeling", "correct": false}, {"label": "B", "text": "Hematoma formation, Inflammation, Callus formation, Remodeling, Modeling", "correct": true}, {"label": "C", "text": "Hematoma formation, Inflammation, Modeling, Remodeling, Callus formation", "correct": false}, {"label": "D", "text": "Callus formation, Hematoma formation, Inflammation, Modeling, Remodeling", "correct": false}], "correct_answer": "B. Hematoma formation, Inflammation, Callus formation, Remodeling, Modeling", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/nZYgus1mPhJ9So68AduV1738210123.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage of hematoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The initial stage lasts up to <strong>7 days</strong>.</li>\n<li>Blood leaks from torn vessels and forms a <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> around the fracture.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"ae97d0e84f169277719537f321c02b\">periosteum</span> and soft tissues are stripped away from the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> ends.</li>\n<li>Fracture ends suffer from <span class=\"customMeta\" data-dictid=\"567171ee391692777190bfb8dbeb3e\">ischemic necrosis</span> over a few millimeters.</li>\n<li>Some osteocytes die, while others become active and help in healing.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage of <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue stage lasts <strong>2-3 weeks</strong>.</li>\n<li>Precursor cells produce blood vessels, fibroblasts, and osteoblasts.</li>\n<li>Soft <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue forms between <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> fragments.</li>\n<li>It provides support without structural rigidity.</li>\n<li>A <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> from the <span class=\"customMeta\" data-dictid=\"40d68b98721692777183c42090e023\">blood clot</span> supports <span class=\"customMeta\" data-dictid=\"3095c5f0fc1692777202eda8060779\">fibroblast</span> and <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> growth.</li>\n<li>Macrophages and giant cells remove the blood clot.</li>\n<li>In bone healing, <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue differentiates into osteoblasts to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> new bone.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage of callus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>This stage lasts 4-12 weeks, during which <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue differentiates into osteoblasts.</li>\n<li>These cells create an <span class=\"customMeta\" data-dictid=\"021501f2831692777190ef9ba827fb\">intercellular</span> <span class=\"customMeta\" data-dictid=\"14958c535b1692777192abd2a85abf\">matrix</span> that becomes impregnated with <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> salts, forming the callus, or woven bone.</li>\n<li>This callus, visible on <span class=\"customMeta\" data-dictid=\"6fda63a90c1692777202563d33a81b\">X-rays</span> about 3 weeks post-fracture, provides initial strength and indicates union.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage of <span class=\"customMeta\" data-dictid=\"c182a5c58f1692777197ad47b9c2ef\">remodeling</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Formerly known as the <span class=\"customMeta\" data-dictid=\"b1357efd5116927771859dfba380e7\">consolidation</span> stage.</li>\n<li>Woven bone is replaced by <span class=\"customMeta\" data-dictid=\"0472620c171692777192c655af9c57\">mature</span> <span class=\"customMeta\" data-dictid=\"95dc7047f41692777191f225afb261\">lamellar</span> bone.</li>\n<li>This occurs in <span class=\"customMeta\" data-dictid=\"688c032c5f169277719340e2e620d1\">multicellular</span> units, with <span class=\"customMeta\" data-dictid=\"e9321290da16927771830865e0eb6e\">callus</span> replaced by <span class=\"customMeta\" data-dictid=\"95dc7047f41692777191f225afb261\">lamellar</span> bone.</li>\n<li>The process is slow, taking 1 to 4 years.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage of <span class=\"customMeta\" data-dictid=\"9801899a201692777192ec0e7f056b\">modeling</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Formerly known as the <span class=\"customMeta\" data-dictid=\"c182a5c58f1692777197ad47b9c2ef\">remodeling</span> stage.</li>\n<li>Bone is gradually strengthened.</li>\n<li>Cortices sharpen at the <span class=\"customMeta\" data-dictid=\"d267c186cd16927771876d6cb7cd2d\">endosteal</span> and <span class=\"customMeta\" data-dictid=\"58c03304521692777195a054ce95e4\">periosteal</span> surfaces.</li>\n<li>Local bone strains from weight-bearing stresses and muscle forces stimulate this process.</li>\n<li>More noticeable in children with angulated fractures.</li>\n<li>Limited <span class=\"customMeta\" data-dictid=\"c182a5c58f1692777197ad47b9c2ef\">remodeling</span> occurs in adult fractures.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/EqTHmbQ2kfHXLhtI5k4l1742905654.mp3", "video": ""}, {"text": "Which of the following statements best describes the differences between primary and secondary fracture healing?", "options": [{"label": "A", "text": "Primary healing involves the formation of a fibrous callus, while secondary healing bypasses the callus stage with direct lamellar bone formation.", "correct": false}, {"label": "B", "text": "Primary healing occurs with absolute stability and direct bone remodeling, while secondary healing is a process involving callus formation and occurs with relative stability.", "correct": true}, {"label": "C", "text": "Primary healing is faster due to the lack of callus formation, while secondary healing is delayed due to endochondral ossification.", "correct": false}, {"label": "D", "text": "Primary healing occurs with undisturbed fracture hematoma, while secondary healing occurs when the hematoma is surgically removed.", "correct": false}], "correct_answer": "B. Primary healing occurs with absolute stability and direct bone remodeling, while secondary healing is a process involving callus formation and occurs with relative stability.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/5iMjK0qs5JEEf0iY4NTv1738209713.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:769px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Primary (Direct) Healing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Secondary (Indirect) Healing</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Process</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Direct bone <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> without <span class=\"customMeta\" data-dictid=\"e9321290da16927771830865e0eb6e\">callus</span> formation. <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Involves the classical stages of healing: hematoma, <span class=\"customMeta\" data-dictid=\"e9321290da16927771830865e0eb6e\">callus</span> formation, and remodeling.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Lamellar bone forms directly across the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> line by <strong>direct extension of osteons</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Healing occurs through <strong>endochondral and <span class=\"customMeta\" data-dictid=\"9ab9c0fe2f169277719065b8b974d7\">intramembranous</span> ossification</strong> with <span class=\"customMeta\" data-dictid=\"e9321290da16927771830865e0eb6e\">callus</span> formation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Fracture Hematoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Occurs when the <strong>fracture <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> is disturbed</strong>, usually in surgically treated fractures. <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Occurs when the <strong>fracture <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> remains undisturbed</strong>, typical of non-operative treatment.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Callus Formation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>No <span class=\"customMeta\" data-dictid=\"e9321290da16927771830865e0eb6e\">callus</span> formation</strong>; difficult to evaluate on <span class=\"customMeta\" data-dictid=\"6fda63a90c1692777202563d33a81b\">X-rays</span> due to direct healing.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Callus formation</strong> is visible on <span class=\"customMeta\" data-dictid=\"6fda63a90c1692777202563d33a81b\">X-rays</span> and bridges the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> site.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Stability Requirement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Requires <strong>absolute stability</strong> with rigid internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> (e.g., <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> plates).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Requires <strong>relative stability</strong>, often managed with <span class=\"customMeta\" data-dictid=\"8c6ba9ffab1692777183324e3a5ed3\">casting</span> or external fixation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Healing Speed</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Slower</strong> <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> due to the direct <span class=\"customMeta\" data-dictid=\"c182a5c58f1692777197ad47b9c2ef\">remodeling</span> of bone. <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Faster</strong> healing, as <span class=\"customMeta\" data-dictid=\"e9321290da16927771830865e0eb6e\">callus</span> provides early mechanical strength.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Mechanical Continuity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Mechanical <span class=\"customMeta\" data-dictid=\"17e718612e1692777185f79acb759b\">continuity</span> is reestablished <strong>without <span class=\"customMeta\" data-dictid=\"e9321290da16927771830865e0eb6e\">callus</span> formation</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Strength is restored by the <strong>callus</strong>, which provides initial stability.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Bone Contact</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Direct contact</strong> between bone <span class=\"customMeta\" data-dictid=\"47251baa4216927771852a326a2d3f\">cortices</span> (anatomical reduction).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Gaps between bone fragments are bridged by <span class=\"customMeta\" data-dictid=\"e9321290da16927771830865e0eb6e\">callus</span> formation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Clinical Use</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Used in <strong>surgically treated fractures</strong> requiring perfect alignment.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Common in non-surgically treated fractures (e.g., casting, external fixation).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>X-ray Evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Hard to evaluate <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> on <span class=\"customMeta\" data-dictid=\"6fda63a90c1692777202563d33a81b\">X-rays</span> due to lack of <span class=\"customMeta\" data-dictid=\"e9321290da16927771830865e0eb6e\">callus</span> formation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Callus formation makes <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> progress <strong>visible on X-rays</strong>.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Bill Rhodes\" data-hash=\"\" data-license=\"CC BY 2.0\" data-source=\"https://en.wikipedia.org/wiki/Bone_healing#/media/File:Communitive_midshaft_humeral_fracture_callus.jpg\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/5iMjK0qs5JEEf0iY4NTv1738209713.png\" width=\"276\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/E75eZwapubALDDdfD3op1742905796.mp3", "video": ""}, {"text": "A 13-year-old obese boy presents with a limp and pain in his left hip and knee that has been gradually worsening over the past month. On examination, his left leg is externally rotated and appears shorter. The hip has limited internal rotation and abduction. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Legg-Calvé-Perthes disease", "correct": false}, {"label": "B", "text": "Septic arthritis of the hip", "correct": false}, {"label": "C", "text": "Slipped capital femoral epiphysis", "correct": true}, {"label": "D", "text": "Developmental dysplasia of the hip", "correct": false}], "correct_answer": "C. Slipped capital femoral epiphysis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cQv3usnitnu1IsCvMGJN1738209554.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:706px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Displacement of the upper <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"0fa073bd8016927771872ee5b57674\">epiphysis</span> at the growth plate, usually postero-medially, resulting in <span class=\"customMeta\" data-dictid=\"62a6c85ad51692777185af1f5463e1\">coxa</span> vara</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age &amp; Gender</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Occurs at <span class=\"customMeta\" data-dictid=\"c284c4252f16927771963c07a95e13\">puberty</span> (between 12-14 years)</li>\n<li>More common in boys</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Obesity</li>\n<li>Endocrine abnormalities</li>\n<li>Short and <span class=\"customMeta\" data-dictid=\"43663fecf11692777194c870d1d548\">obese</span> children</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pain in the groin, often radiating to the thigh and knee</li>\n<li>Limp</li>\n<li><strong>External <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> of the affected leg, Shortening of the limb.</strong></li>\n<li>Limitation of hip movements, especially <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> and internal rotation</li>\n<li>Positive Trendelenburg's sign</li>\n<li><strong>Drehmann's Sign</strong> is characterized by external <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> and <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> of the hip when the knee is flexed, indicating <span class=\"customMeta\" data-dictid=\"acb259200b16927771908888d1377c\">instability</span> or weakness in the hip joint</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiological Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Best seen on the<strong> X-ray: <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> view of the hip</strong></li>\n<li><strong>AP view:</strong> <span class=\"customMeta\" data-dictid=\"3480d51034169277718862050fed12\">Growth plate</span> displaced towards metaphyseal side</li>\n<li><strong>Lateral view:</strong> Head is angulated on the neck</li>\n<li><strong>Klein's Line:</strong> This is an <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> line drawn on an <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> of the hip, where a line is drawn along the superior aspect of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> neck. The line should intersect the capital <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> epiphysis. If the <span class=\"customMeta\" data-dictid=\"0fa073bd8016927771872ee5b57674\">epiphysis</span> is above this line, it indicates a potential <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> or <span class=\"customMeta\" data-dictid=\"e7ed1a964716927771801ab913204a\">abnormality</span> in the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head.</li>\n<li><strong>Trethowan Sign:</strong> This sign is observed on an <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> when there is a widening of the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> joint space of the hip, indicating a possible <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head. It may also suggest a higher likelihood of <span class=\"customMeta\" data-dictid=\"ffadabff021692777194c8ebe87262\">osteonecrosis</span> in the affected hip.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Acute slip:</strong> <span class=\"customMeta\" data-dictid=\"da014870171692777184980beab405\">Closed reduction</span> and pinning</li>\n<li><strong>Gradual slip:</strong> Depends on severity; <span class=\"customMeta\" data-dictid=\"96aaaa68ce1692777190096abe3c8a\">in situ</span> <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> or corrective osteotomy</li>\n<li>Prophylactic pinning of unaffected side in <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> cases</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/jcELbbrhXqaaow1aNEh81742904735.mp3", "video": ""}, {"text": "A 45-year-old man is admitted to the orthopedic ward with a supracondylar fracture of the humerus. The orthopedic surgeon decides to apply traction as part of the treatment plan. Which of the following traction methods would be most appropriate for this patient?", "options": [{"label": "A", "text": "Skin traction with adhesive plaster", "correct": false}, {"label": "B", "text": "Skeletal traction with Steinmann pin", "correct": true}, {"label": "C", "text": "Russell's traction", "correct": false}, {"label": "D", "text": "Bryant's traction", "correct": false}], "correct_answer": "B. Skeletal traction with Steinmann pin", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/KbkIoweS0X9mg2GjyITv1738209393.png", "https://image.prepladder.com/content/IthHw2RctpGCw6Qj5B9z1738209433.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:688px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skin Traction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skeletal Traction</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Required force</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild to moderate force</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate to severe force</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age used for</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Children</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adults</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Applied with</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adhesive plaster</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Steinmann pin, K-wire</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Applied on</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>On skin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Through bone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Weight permitted</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Up to 3-4 kg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Up to 20 kg</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Used for</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Short duration</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Long duration</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Image</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"300\" src=\"https://image.prepladder.com/content/KbkIoweS0X9mg2GjyITv1738209393.png\" width=\"300\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"300\" src=\"https://image.prepladder.com/content/IthHw2RctpGCw6Qj5B9z1738209433.png\" width=\"300\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/mpNhXcAfgBIbApzQPnVs1742902995.mp3", "video": ""}, {"text": "A 42-year-old software developer presents with pain and tenderness on the outer aspect of her right elbow. The pain worsens when she extends her wrist against resistance. She denies any recent injury but mentions spending long hours typing and using a mouse. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Golfer’s elbow", "correct": false}, {"label": "B", "text": "Student’s elbow", "correct": false}, {"label": "C", "text": "Tennis elbow", "correct": true}, {"label": "D", "text": "Cubital tunnel syndrome", "correct": false}], "correct_answer": "C. Tennis elbow", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:721px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A condition characterized by pain and <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> at the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"9cdc5a92a216927771870d4b257a80\">epicondyle</span> of the <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> due to non-specific <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> at the origin of the <span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\">extensor</span> muscles of the forearm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Overuse of <span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\">extensor</span> muscles</li>\n<li>Repetitive activities (e.g., tennis, typing, using mouse)</li>\n<li>Non-specific <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> at muscle origin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pain and <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> precisely <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> to the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"9cdc5a92a216927771870d4b257a80\">epicondyle</span> of the humerus</li>\n<li>Pain aggravated by extending the wrist against resistance</li>\n<li>Normal <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> findings</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Cozen's test:</strong> Also known as the resisted wrist extension test or <span class=\"customMeta\" data-dictid=\"8459151fee1692777197d1ac765aa0\">resistive</span> <span class=\"customMeta\" data-dictid=\"bfe689a0b21692777200b9437fa418\">tennis elbow</span> test, this test involves the patient making a fist and resisting wrist extension while the examiner applies pressure. The test is positive if the patient experiences pain on the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> epicondyle.</li>\n<li><strong>Maudsley's test: </strong>This test involves the patient pronating their <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> and resisting extension of the third <span class=\"customMeta\" data-dictid=\"02e6b5c95316927771867eba7818b1\">digit</span> of their hand while the examiner stabilizes the humerus. The test is positive if the patient experiences sudden pain on the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> epicondyle.</li>\n<li><strong>Mills's test:</strong> Another common test for tennis elbow.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Initial: Analgesics, anti-inflammatory drugs</li>\n<li>If no response: Local <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> of <span class=\"customMeta\" data-dictid=\"3ad7a8484f16927771892d460daa4b\">hydrocortisone</span> at the point of maximum tenderness</li>\n<li>Physical therapy and activity modification</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/sdZh4kpd4UlZYDNiGgyf1742902279.mp3", "video": ""}, {"text": "A 55-year-old man with a history of alcohol abuse presents to the clinic with difficulty straightening his right hand as shown in the image below. He mentions that this has progressively worsened over the past year. Which of the following statements is false regarding the condition he may be experiencing?", "options": [{"label": "A", "text": "The flexion deformity primarily affects the distal interphalangeal joints of the fingers.", "correct": true}, {"label": "B", "text": "Thickening of the palmar aponeurosis is a key feature of this condition.", "correct": false}, {"label": "C", "text": "Individuals with liver cirrhosis have a higher incidence of this condition.", "correct": false}, {"label": "D", "text": "Observation is often sufficient for mild cases of this condition.", "correct": false}], "correct_answer": "A. The flexion deformity primarily affects the distal interphalangeal joints of the fingers.", "question_images": ["https://image.prepladder.com/content/ZTFOs1kwRhKMjUoclAZV1738046615.png"], "explanation_images": ["https://image.prepladder.com/content/QCVrqer0LgXkta9euRnL1738046681.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A condition characterized by a <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> of one or more fingers due to thickening and shortening of the <span class=\"customMeta\" data-dictid=\"236c57792f1692777194be265ad6db\">palmar</span> aponeurosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathoanatomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Thickening of the <span class=\"customMeta\" data-dictid=\"236c57792f1692777194be265ad6db\">palmar</span> <span class=\"customMeta\" data-dictid=\"52cb21596b1692777181aa72f1feb5\">aponeurosis</span> <strong>(Option B)</strong></li>\n<li>Involvement of <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> sheaths and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> digital sheet</li>\n<li>Progressive <span class=\"customMeta\" data-dictid=\"3c13e3c8e91692777185822d4393f9\">contracture</span> leading to finger flexion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Early stages: Thickening at <span class=\"customMeta\" data-dictid=\"1ec6e3e9e11692777182b1220b131a\">bases</span> of ring and little fingers</li>\n<li>Later stages: <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">Flexion</span> <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> of fingers</li>\n<li>Primarily affects ring finger, then little finger</li>\n<li>MP and <span class=\"customMeta\" data-dictid=\"bc2c34fe2216927771957ca73ba3d9\">PIP</span> joints are flexed, DIP joints often not affected</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> in cirrhotic patients (alcohol abuse) <strong>(Option C)</strong></li>\n<li>Association with epileptics on sodium hydantoin</li>\n<li>Possible genetic predisposition</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mild cases: Observation <strong>(Option D)</strong></li>\n<li>Severe cases: <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> of the <span class=\"customMeta\" data-dictid=\"236c57792f1692777194be265ad6db\">palmar</span> aponeurosis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/YdQJKA9Ee13jJ3AnP1LS1742117705.mp3", "video": ""}, {"text": "A 45-year-old woman presents with numbness and tingling in her thumb, index, and middle fingers. Symptoms worsen at night and improve during the day. She also reports hand and wrist pain, along with weakness in her grip. Which of the following clinical signs is consistent with her condition?", "options": [{"label": "A", "text": "Thumb opposition and abduction is spared.", "correct": false}, {"label": "B", "text": "Sensory loss affecting the entire hand.", "correct": false}, {"label": "C", "text": "Atrophy of the thenar eminence.", "correct": true}, {"label": "D", "text": "Pain and paresthesias arise during wrist extension.", "correct": false}], "correct_answer": "C. Atrophy of the thenar eminence.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:719px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Compression of the <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> nerve as it passes through the <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> tunnel in the wrist</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Numbness, <span class=\"customMeta\" data-dictid=\"b7020a23961692777200b1237ae429\">tingling</span> in thumb, index, and middle fingers</li>\n<li>Pain in hand and wrist</li>\n<li>Weakness in grip</li>\n<li>Symptoms often <strong>worse at night </strong>and improve during the day.</li>\n<li>Advanced cases may lead to constant symptoms, hand weakness, clumsiness, and muscle atrophy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structures Affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Median Nerve</strong>: Compressed within the <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> tunnel, leading to symptoms and signs.</li>\n<li><strong>Flexor Tendons</strong>: The nine <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> tendons passing through the <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> tunnel can become inflamed, further compressing the <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> nerve.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structures Spared</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Thenar Eminence</strong>: <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">Sensory</span> loss generally spares this area because its nerve (palmar <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> nerve) bypasses the <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> tunnel.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Weakness: </strong>Notable weakness in thumb <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> and opposition. <strong>(Option A)</strong></li>\n<li><strong>Atrophy</strong>: Possible <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> of the <span class=\"customMeta\" data-dictid=\"48c587f4c51692777200fe869f1699\">thenar</span> <span class=\"customMeta\" data-dictid=\"c7cd7c82631692777187abb016ed2e\">eminence</span> in advanced cases.</li>\n<li><strong>Sensory Loss</strong>: Loss typically affects the <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> nerve distribution (thumb, index, middle, and <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> half of the fourth digit). <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Idiopathic-</strong> commonest cause</li>\n<li><strong>Inflammatory causes- </strong>Rheumatoid arthritis, wrist osteoarthritis</li>\n<li><strong>Post-traumatic causes-</strong> Bone thickening after a Colles' fracture</li>\n<li><strong>Endocrine causes-</strong> Myxoedema, Acromegaly</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nerve <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">Conduction</span> Studies (NCS) - primary <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test</li>\n<li>Electromyography (EMG)</li>\n<li><strong>Carpal <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">Compression</span> Test</strong>: Positive if pain/paresthesias occur during pressure application over the <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> tunnel.</li>\n<li><strong>Phalen Test</strong>: Positive if pain/paresthesias arise during wrist flexion. <strong>(Option D)</strong></li>\n<li><strong>Tinel Test:</strong> Positive if tapping over the <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> tunnel elicits symptoms.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Conservative: Wrist splinting, NSAIDs, activity modification</li>\n<li>Corticosteroid injections</li>\n<li>Surgical: <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">Carpal</span> tunnel release (for severe or <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> cases)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/t4Yv95exNE3fT8Xo89x71742048611.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 31 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 3</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">General-Previous Year Questions - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 3</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 3 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "The given image is of an ulcer, identify the marked structure?", "options": [{"label": "A", "text": "Margin", "correct": false}, {"label": "B", "text": "Edge", "correct": true}, {"label": "C", "text": "Floor", "correct": false}, {"label": "D", "text": "Base", "correct": false}], "correct_answer": "B. Edge", "question_images": ["https://image.prepladder.com/content/3n8GoJsAETkxnp4HVJly1741111534.png"], "explanation_images": ["https://image.prepladder.com/content/PV1RL6iYEdLsFJET3bJi1741111552.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Part</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Margin </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Outer limit of the ulcer, usually blending into the surrounding skin/mucosa.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Edge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The border between the margin and the <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> floor, may be raised (malignant), undermined (tuberculous), or <span class=\"customMeta\" data-dictid=\"7134f7f8681692777196fa644c43bf\">punched-out</span> (syphilitic).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Floor </strong><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The exposed surface inside the ulcer, may contain slough, <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue, or necrosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Base </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The structure beneath the ulcer, which can be soft tissue, bone, or a vessel.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient experiencing excessive bleeding, with limbs displaying low temperature and reduced central venous pressure (CVP), what type of shock is observed?", "options": [{"label": "A", "text": "Cardiogenic shock", "correct": false}, {"label": "B", "text": "Hypovolemic shock", "correct": true}, {"label": "C", "text": "Obstructive shock", "correct": false}, {"label": "D", "text": "Hypo adrenal shock", "correct": false}], "correct_answer": "B. Hypovolemic shock", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/6nTSx6ZBX659oD8ShHHt1746976815.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:415px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pathophysiology of Hypovolemic shock</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"602\" src=\"https://image.prepladder.com/content/6nTSx6ZBX659oD8ShHHt1746976815.png\" width=\"602\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:601px\">\n<tbody>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Physiological Hemodynamic Characteristics of Shock</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type of Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cardiac Output</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Systemic Vascular Resistance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Central Venous Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mean Arterial Pressure</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypovolemic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cardiogenic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Distributive(Septic, anaphylactic, neurogenic)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑ or ↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓ or N</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Obstructive (pulmonary embolism, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> tamponade, tension pneumothorax)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a hypotensive patient with a head injury, which of the subsequent fluids should be avoided?", "options": [{"label": "A", "text": "0.9% NS", "correct": false}, {"label": "B", "text": "5% Dextrose", "correct": true}, {"label": "C", "text": "Ringer lactate", "correct": false}, {"label": "D", "text": "3% saline", "correct": false}], "correct_answer": "B. 5% Dextrose", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 13 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 24</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Images And Instruments-Orthopedic Disorders And Instruments - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 24</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 24 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 34-year-old woman complains of difficulty walking. She notices her right hip drops when she steps on her left leg, and she has to lean her body to the left to maintain balance. She has a history of hip dysplasia. Examination shows weakness in the left hip abductors. Which of the following gait types does this best represent?", "options": [{"label": "A", "text": "Scissoring Gait", "correct": false}, {"label": "B", "text": "Trendelenburg Gait", "correct": true}, {"label": "C", "text": "Antalgic Gait", "correct": false}, {"label": "D", "text": "Short Limb Gait", "correct": false}], "correct_answer": "B. Trendelenburg Gait", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Abnormal <span class=\"customMeta\" data-dictid=\"053afdc7031692777187c2079a86a3\">Gait</span> types</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antalgic Gait</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Characterised by a markedly shortened <span class=\"customMeta\" data-dictid=\"d3d2a26e231692777199a20a234076\">stance phase</span> on the affected side.</li>\n<li>Pain prompts the patient to shift body weight quickly to the normal leg.</li>\n<li>Results in <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> time spent on the affected leg.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Short Limb Gait</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Apparent when the limb is shorter than 2 inches.</li>\n<li>The body on the affected side moves up and down with weight <span class=\"customMeta\" data-dictid=\"2bb6ddacfd169277718230a816b21f\">bearing</span> on the affected leg.</li>\n<li>It can be due to a <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> short <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> or shortening secondary to fracture.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Trendelenburg Gait</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The body swings to the affected side when weight is borne.</li>\n<li>Indicates functionally weak hip <span class=\"customMeta\" data-dictid=\"1a19c0413216927771801f371db10e\">abductor</span> muscles.</li>\n<li>Associated conditions include a dislocated hip, <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"62a6c85ad51692777185af1f5463e1\">coxa</span> vara, DDH, <span class=\"customMeta\" data-dictid=\"ff2029fa511692777188fef4dab16c\">greater trochanter</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> and fractured neck of the femur.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High stepping Gait</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Occurs due to foot drop; the leg is lifted higher for clearance.</li>\n<li>First contact with the ground is made by the <span class=\"customMeta\" data-dictid=\"ca68a3fb831692777203e5f4094b97\">forefoot</span> rather than the heel.</li>\n<li>Commonly seen in <strong>peroneal nerve <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> or <span class=\"customMeta\" data-dictid=\"1cb6159469169277719843ab627a07\">sciatic</span> nerve palsy</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hand on knee Gait</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The individual walks with their hand on the knee to prevent buckling.</li>\n<li>Typically associated with <strong>quadriceps <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> </strong>and <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> deformity.</li>\n<li>Common in <span class=\"customMeta\" data-dictid=\"7b1b23cdec1692777196fb5ec9f3f5\">polio</span> patients.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Quadriceps <span class=\"customMeta\" data-dictid=\"d61e782bf41692777182f829eef312\">Avoidance</span> Gait</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Characterised by <span class=\"customMeta\" data-dictid=\"2ad2fb4cc8169277718925a677620c\">hyperextension</span> of the knee to lock it.</li>\n<li>Compensates for <span class=\"customMeta\" data-dictid=\"175fd4b3061692777196c7f28a4c53\">quadriceps</span> paralysis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Scissoring Gait</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Legs cross in front of each other while walking.</li>\n<li>Caused by spasms of the hip adductors, often associated with cerebral palsy.</li>\n<li>Results in a stiff-legged appearance.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/b5hLHuVRMlHqANSay3B41745057250.mp3", "video": ""}, {"text": "Which of the following locations is the most common site for a ganglion cyst on the wrist?", "options": [{"label": "A", "text": "Volar aspect near the radial artery", "correct": false}, {"label": "B", "text": "Dorsal side of the scapholunate ligament", "correct": true}, {"label": "C", "text": "Over the second carpometacarpal joint", "correct": false}, {"label": "D", "text": "Palmar side of the scaphoid-trapezium-trapezoid joint", "correct": false}], "correct_answer": "B. Dorsal side of the scapholunate ligament", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/8Ev5kXM07jsBkj7TwjWt1738036736.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/JRhHaVWoHgbPb5aub7mm1745058976.mp3", "video": ""}, {"text": "A 55 y/o woman with a 15-year history of poorly controlled diabetes presents with stiffness and reduced movement in her fingers, primarily on the ulnar side. Which clinical sign is specific to this condition?", "options": [{"label": "A", "text": "Table top sign", "correct": true}, {"label": "B", "text": "Tinel’s sign", "correct": false}, {"label": "C", "text": "Kanavel’s sign", "correct": false}, {"label": "D", "text": "Finkelstein’s test", "correct": false}], "correct_answer": "A. Table top sign", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/0j9hFuDxmIzNHsGaVm1O1738036654.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/kcRnwU6BiCQuOrSkSvFI1745058837.mp3", "video": ""}, {"text": "A 45 y/o male presents with redness, swelling, and pain in the thumb after sustaining a puncture wound two days ago. The thumb is held in a flexed position, and the patient experiences severe pain when attempting to straighten it. There is also swelling over the thenar eminence. Which of the following is the most appropriate next step in management?", "options": [{"label": "A", "text": "Apply a splint and prescribe oral antibiotics", "correct": false}, {"label": "B", "text": "Immediate surgical drainage", "correct": false}, {"label": "C", "text": "Initiate intravenous antibiotics and monitor for 24 hours", "correct": true}, {"label": "D", "text": "Request an X-ray to confirm the diagnosis", "correct": false}], "correct_answer": "C. Initiate intravenous antibiotics and monitor for 24 hours", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25 y/o patient presents with a complex open fracture of the leg after a motor vehicle accident. The fracture has significant bone loss and the patient is seeking treatment options. The orthopaedic surgeon discusses two potential methods: the Ilizarov fixator and the rail fixator. Which of the following statements is true regarding the treatment options for this patient?", "options": [{"label": "A", "text": "The Ilizarov fixator is not suitable for limb lengthening or deformity corrections.", "correct": false}, {"label": "B", "text": "The rail fixator does not require daily adjustments by the patient or family member.", "correct": false}, {"label": "C", "text": "In the Ilizarov fixator only the cortex of the bone is cut, preserving periosteum.", "correct": true}, {"label": "D", "text": "The rail fixator is superior to the Ilizarov fixator in treating complex fractures.", "correct": false}], "correct_answer": "C. In the Ilizarov fixator only the cortex of the bone is cut, preserving periosteum.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/gUTqBOG9oT2jEoXUnFcF1738036303.png", "https://image.prepladder.com/content/PFxc3v9wjdP4kYasmgaS1738036385.png", "https://image.prepladder.com/content/qagVmgDYh7F1FR7bGOSM1738036471.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/q4DOG7SMz4ja7WWOya6G1745058325.mp3", "video": ""}, {"text": "Match the following instruments with their respective uses given in the X-Rays 1. Proximal Femur Nail a) 2. Kuntscher Nail b) 3. Steinmann Pin c) 4. Kirschner Wire d)", "options": [{"label": "A", "text": "1-b, 2-c, 3-a, 4-d", "correct": false}, {"label": "B", "text": "1-a, 2-b, 3-d, 4-c", "correct": false}, {"label": "C", "text": "1-c, 2-b, 3-d, 4-a", "correct": false}, {"label": "D", "text": "1-b, 2-d, 3-a, 4-c", "correct": true}], "correct_answer": "D. 1-b, 2-d, 3-a, 4-c", "question_images": ["https://image.prepladder.com/content/HciQG5A9seMmRRGCDNKx1738036872.png", "https://image.prepladder.com/content/OgE23JOJZnwzqEIphPli1738037010.png", "https://image.prepladder.com/content/orSPogDjGwT51SLickw61738037092.png", "https://image.prepladder.com/content/Upe7eL0D429LlNUhu8rS1738037231.png"], "explanation_images": ["https://image.prepladder.com/content/n1gXXRv4t128r6U7jfD51738037318.png", "https://image.prepladder.com/content/Z7gDYDQkEVLOS8fHkTvL1738037395.png", "https://image.prepladder.com/content/p7HxopPVxwqBUfyYslvR1738037468.png", "https://image.prepladder.com/content/TDT8NuQcTrlDzICVc4Bt1738037558.png", "https://image.prepladder.com/content/fDWVV4jx7RMA5FjAkbjj1738037630.png", "https://image.prepladder.com/content/mwNicDICi09Q1pvB6z0H1738037700.png", "https://image.prepladder.com/content/ReQRZtPVlHQaGospNnnW1738037766.png", "https://image.prepladder.com/content/zyWW7oeaIIbXJTup1S5P1738037831.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:1500px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Instrument</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Images</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n<p><strong>Proximal <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">Femur</span> Nail (PFN)</strong></p>\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">Proximal</span> <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">Femoral</span> Nail (PFN) is used for closed <span class=\"customMeta\" data-dictid=\"5b22285eec169277719026820db11c\">intramedullary</span> <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> of <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> fractures.</li>\n<li>It features two <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> openings for a <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> neck <span class=\"customMeta\" data-dictid=\"6ef2a80e2116927771915098fa1789\">lag</span> screw and an anti-rotation screw.</li>\n<li>Indications include peritrochanteric, intertrochanteric, and <span class=\"customMeta\" data-dictid=\"6aad7ac3ba16927771992f27501295\">subtrochanteric</span> fractures.</li>\n<li>It is contraindicated for <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> neck fractures.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Bullenwächter\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Proximal_femur_nail.jpg\" data-tags=\"\" src=\"https://image.prepladder.com/content/n1gXXRv4t128r6U7jfD51738037318.png\"/><img alt=\"\" data-author=\"Hellerhoff\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Femurfraktur_unter_Bisphosphonattherapie_57W_-_CT_Topo_Volumen_Rendering_postoperatives_Roentgen_-_001.jpg\" data-tags=\"\" src=\"https://image.prepladder.com/content/Z7gDYDQkEVLOS8fHkTvL1738037395.png\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Kuntscher Nial</strong></p>\n\t\t\t \n\n\t\t\t<ul>\n<li>Used for internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> of <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> fractures.</li>\n<li>The nail is a <span class=\"customMeta\" data-dictid=\"3f9a320e1a169277718983ee3d1860\">hollow</span> tube with a cloverleaf shape for rotational stability.</li>\n<li>Fixation is based on three-point fixation: at both ends and the isthmus.</li>\n<li>Each end has an \"eye\" for the <span class=\"customMeta\" data-dictid=\"42e78986ec16927771874f3766e591\">extractor</span> hook during removal.</li>\n<li>Nail size is determined by measuring from the <span class=\"customMeta\" data-dictid=\"ff2029fa511692777188fef4dab16c\">greater trochanter</span> to the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"9d86b5d3351692777190224c62427b\">knee joint</span> line and subtracting 2 cm.</li>\n<li>About 2 cm of the nail is left protruding at the <span class=\"customMeta\" data-dictid=\"c4bb41d0e016927772003539a49a35\">trochanter</span> for removal, usually 2 years post-operation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n<p> <img alt=\"\" data-author=\"Bharti A, Kumar S, Kushwaha S, et al.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.cureus.com/articles/38799-kuntscher-nail-a-forgotten-entity-yet-a-reliable-modality-in-treatment-of-winquist-type-i-and-ii-closed-femoral-shaft-fractures#!/authors\" data-tags=\"\" src=\"https://image.prepladder.com/content/p7HxopPVxwqBUfyYslvR1738037468.png\"/></p>\n<p><img alt=\"\" data-author=\"Bharti A, Kumar S, Kushwaha S, et al.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.cureus.com/articles/38799-kuntscher-nail-a-forgotten-entity-yet-a-reliable-modality-in-treatment-of-winquist-type-i-and-ii-closed-femoral-shaft-fractures#!/authors\" data-tags=\"\" src=\"https://image.prepladder.com/content/TDT8NuQcTrlDzICVc4Bt1738037558.png\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Kirschner wire (K wire)</strong></p>\n\t\t\t \n\n\t\t\t<ul>\n<li>Thin, straight steel wire with a <span class=\"customMeta\" data-dictid=\"afb15e4a331692777186e495b370a1\">diameter</span> of 1 to 3 mm.</li>\n<li>Uses include:\n\t\t\t\t<ul>\n<li>Internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> of small bones.</li>\n<li>Tension band <span class=\"customMeta\" data-dictid=\"6ef263e89e169277720230becfc5ec\">wiring</span> in patella</li>\n<li>Applying <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> (e.g., through the olecranon).</li>\n<li>Fixing fractures in children.</li>\n<li>Used in Ilizarov’s <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> system.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> <img alt=\"\" data-author=\"Netha Hussain\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:K_wire.jpg\" data-tags=\"\" src=\"https://image.prepladder.com/content/fDWVV4jx7RMA5FjAkbjj1738037630.png\"/></p>\n<p><img alt=\"\" data-author=\"Hellerhoff\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Zuggurtungs-Osteosynthese_bei_Patella-Querfraktur.png\" data-tags=\"\" src=\"https://image.prepladder.com/content/mwNicDICi09Q1pvB6z0H1738037700.png\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Steinmann Pin</strong></p>\n\t\t\t \n\n\t\t\t<ul>\n<li>Stout, straight steel rod with a <span class=\"customMeta\" data-dictid=\"afb15e4a331692777186e495b370a1\">diameter</span> of 3 to 6 mm.</li>\n<li>Primarily used for skeletal traction.</li>\n<li>Common sites for <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> include the upper end of the tibia, the <span class=\"customMeta\" data-dictid=\"043a86fa0016927771998a67e65e6a\">supracondylar</span> region of the femur, and the calcaneum.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> <img alt=\"\" data-author=\"Netha Hussain\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Steinman_pins.jpg\" data-tags=\"\" src=\"https://image.prepladder.com/content/ReQRZtPVlHQaGospNnnW1738037766.png\"/></p>\n<p><img alt=\"\" data-author=\"DeFroda, Steven &amp; Gil, Joseph &amp; Born, Christopher. \" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Distal-femoral-traction-pin-landmarks-a-The-patella-is-marked-four-dots-as-well-as_fig2_305633840\" data-tags=\"\" src=\"https://image.prepladder.com/content/zyWW7oeaIIbXJTup1S5P1738037831.png\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/847577_.mp3", "video": ""}, {"text": "Identify the given instrument", "options": [{"label": "A", "text": "Bohler stirrup", "correct": false}, {"label": "B", "text": "Periosteal elevator", "correct": true}, {"label": "C", "text": "Osteotome", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "B. Periosteal elevator", "question_images": ["https://image.prepladder.com/content/1Bb4xD1SWMMpnSEBXNZ61738035821.png"], "explanation_images": ["https://image.prepladder.com/content/tDhmNQtQiuOQkrHD1R2S1738035883.png", "https://image.prepladder.com/content/PlXAHUBolcsJ5cBWYmXD1738035943.png", "https://image.prepladder.com/content/ODkkQo3efpUaSETU4U1c1738036007.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Instrument </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Periosteal Elevator </strong><strong>(Option B)</strong></p>\n<p><img alt=\"\" data-author=\"Netha Hussain\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Farabeauf_periosteal_elevator.jpg\" data-tags=\"\" height=\"127\" src=\"https://image.prepladder.com/content/tDhmNQtQiuOQkrHD1R2S1738035883.png\" width=\"500\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Used to elevate the <span class=\"customMeta\" data-dictid=\"ae97d0e84f169277719537f321c02b\">periosteum</span> during bone operations.</li>\n<li>Elevating the <span class=\"customMeta\" data-dictid=\"ae97d0e84f169277719537f321c02b\">periosteum</span> allows access to important structures like vessels, nerves, and tendons.</li>\n<li>Muscles of the <span class=\"customMeta\" data-dictid=\"c8ed8e0fb61692777187c860f7056f\">extremity</span> are attached to the <span class=\"customMeta\" data-dictid=\"ae97d0e84f169277719537f321c02b\">periosteum</span> and are lifted with it.</li>\n<li>Not used in some procedures, such as the <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> of osteochondroma, where the <span class=\"customMeta\" data-dictid=\"ae97d0e84f169277719537f321c02b\">periosteum</span> is removed completely to prevent recurrence.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Osteotome </strong><strong>(Option C)</strong></p>\n<p><img alt=\"\" data-author=\"Saltanat ebli\" data-hash=\"\" data-license=\"CC0 1.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Osteotome_01.png\" data-tags=\"\" height=\"2738\" src=\"https://image.prepladder.com/content/PlXAHUBolcsJ5cBWYmXD1738035943.png\" width=\"500\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Used for osteotomy, which involves cutting a bone.</li>\n<li>Both edges of the <span class=\"customMeta\" data-dictid=\"e9ab9fcdfc1692777194baf7dce8d6\">osteotome</span> are bevelled.</li>\n<li>Available in different blade widths.</li>\n<li>Commonly used for procedures like McMurray’s <span class=\"customMeta\" data-dictid=\"d1ed4aacdf1692777194c9aa2fc2ac\">osteotomy</span> for the neck of <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> fractures and corrective osteotomies for deformities such as <span class=\"customMeta\" data-dictid=\"7e0d837a391692777188b2820de5f4\">genu</span> varum and <span class=\"customMeta\" data-dictid=\"7e0d837a391692777188b2820de5f4\">genu</span> valgum.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bohler’s <span class=\"customMeta\" data-dictid=\"ed07d4ffa61692777199a9a50d1971\">Stirrup</span> </strong><strong>(Option A)</strong></p>\n<p><img alt=\"\" data-author=\"Netha Hussain\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Bohler%27s_stirrup.jpg\" data-tags=\"\" height=\"293\" src=\"https://image.prepladder.com/content/ODkkQo3efpUaSETU4U1c1738036007.png\" width=\"500\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A device used for holding a <span class=\"customMeta\" data-dictid=\"6bf0e6cef116927771997d19caabc8\">Steinmann pin</span> and applying traction.</li>\n<li>Side screws secure the pin in place.</li>\n<li>Allows for changing the direction of <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> without moving the pin inside the bone.</li>\n<li>Helps avoid <span class=\"customMeta\" data-dictid=\"15228e561416927771918a5e9e15db\">loosening</span> of the pin during <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> adjustments.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/_847576_.mp3", "video": ""}, {"text": "Match the following instruments 1. Bone nibbler a) 2. Bone cutter b) 3. Bone curette c) 4. Bone gouge d)", "options": [{"label": "A", "text": "1-b, 2-c, 3-d, 4-a", "correct": false}, {"label": "B", "text": "1-c, 2-a, 3-d, 4-b", "correct": true}, {"label": "C", "text": "1-d, 2-b, 3-c, 4-a", "correct": false}, {"label": "D", "text": "1-a, 2-d, 3-b, 4-c", "correct": false}], "correct_answer": "B. 1-c, 2-a, 3-d, 4-b", "question_images": ["https://image.prepladder.com/content/Rk1OJtCw8rh9fLFSnxjB1738035192.png", "https://image.prepladder.com/content/oKZ2tMRVZpn2DjqtDOHt1738035274.png", "https://image.prepladder.com/content/m2ElByyEmstDe55zVLkg1738035336.png", "https://image.prepladder.com/content/f4r1IsOei4mOHFNdPVa81738035405.png"], "explanation_images": ["https://image.prepladder.com/content/B0xS7bpF4Smv7WVe2VBL1738035463.png", "https://image.prepladder.com/content/oBjRy2RTuUuUtWOErCVZ1738035527.png", "https://image.prepladder.com/content/poyqrh1HJzvm6mwrEYzd1738035577.png", "https://image.prepladder.com/content/RwV898WsoZ9v1vyUGuES1738035632.png", "https://image.prepladder.com/content/wgSfGdtBa6UwOZzt3KgV1738035675.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone Nibbler</strong></p>\n<p><img alt=\"\" data-author=\"Netha Hussain\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Double_action_bone_nibbler.jpg\" data-tags=\"\" src=\"https://image.prepladder.com/content/B0xS7bpF4Smv7WVe2VBL1738035463.png\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Used for nibbling bone.</li>\n<li>Available in various sizes and angles.</li>\n<li>Common types include:\n\t\t\t\t<ul>\n<li>Straight Nibbler: General use.</li>\n<li>Curved Nibbler: Used in <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> surgery.</li>\n<li>Double Action Nibbler: Can be straight or curved; mechanically superior.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone Cutter</strong></p>\n<p><img alt=\"\" data-author=\"Bszsurgico\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Bone_cutter.jpg\" data-tags=\"\" src=\"https://image.prepladder.com/content/oBjRy2RTuUuUtWOErCVZ1738035527.png\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Used for cutting bone into small pieces, such as for bone grafts.</li>\n<li>Available in straight or curved ends.</li>\n<li>Can be a double-action type.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone Curette</strong></p>\n<p><img alt=\"\" data-author=\"AfroBrazilian\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Bone_Curette_01.jpg\" data-tags=\"\" src=\"https://image.prepladder.com/content/poyqrh1HJzvm6mwrEYzd1738035577.png\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Used for curetting cavities in bone or removing <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> tissue from old <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> ends.</li>\n<li>Curettage is performed for:\n\t\t\t\t<ul>\n<li>Benign tumours like <span class=\"customMeta\" data-dictid=\"eb09882b721692777187c770252147\">enchondroma</span> and giant cell tumours.</li>\n<li>Infections like <span class=\"customMeta\" data-dictid=\"daf5ee63361692777201129f498a4d\">tubercular</span> cavities and osteomyelitis.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone Gouge</strong></p>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" src=\"https://image.prepladder.com/content/RwV898WsoZ9v1vyUGuES1738035632.png\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"9b5c0ed1601692777184e597f453c9\">concave</span> bladed chisel.</li>\n<li>Used for cutting round bone surfaces or making round holes in bone.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone Holding Forceps</strong></p>\n<p><img alt=\"\" data-author=\"Wellcome Images\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Bone_forceps_and_necrosis_forceps,_ancient_and_modern._Wellcome_M0000161.jpg\" data-tags=\"\" src=\"https://image.prepladder.com/content/wgSfGdtBa6UwOZzt3KgV1738035675.png\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Different types are used to hold bones:\n\t\t\t\t<ul>\n<li>Lane’s Forceps: For holding the femur, tibia, etc.</li>\n<li>Lion-Toothed Forceps</li>\n<li>Self-Retaining Forceps: AO type for secure holding.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/847575_.mp3", "video": ""}, {"text": "An 80 y/o woman presents with a fractured neck of the femur due to a fall. She has a history of osteoporosis and is in poor general health. After discussing her options, the orthopaedic surgeon recommends a prosthesis for her condition. Which type of hip prosthesis would be most suitable for this patient, considering her age and health status?", "options": [{"label": "A", "text": "Austin-Moore Prosthesis", "correct": true}, {"label": "B", "text": "Thompson Prosthesis", "correct": false}, {"label": "C", "text": "Charnley's Total Hip Prosthesis", "correct": false}, {"label": "D", "text": "Muller's Total Hip Prosthesis", "correct": false}], "correct_answer": "A. Austin-Moore Prosthesis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Ft0IWlzv2twN750hiQmy1738034917.png", "https://image.prepladder.com/content/AeW4NLUm7le42WEJXgm81738315074.png", "https://image.prepladder.com/content/EKmEusoIOHo3KJsY0odC1738315235.png", "https://image.prepladder.com/content/IFVVzy5NQDf7vmYr83BQ1738035014.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/847574_.mp3", "video": ""}, {"text": "Match the following 1. Cortical screw a) 2. Cancellous screw b) 3. Lag screw c) 4. Dynamic hip screw d)", "options": [{"label": "A", "text": "1-b, 2-c, 3-d, 4-a", "correct": false}, {"label": "B", "text": "1-a, 2-d, 3-c, 4-b", "correct": false}, {"label": "C", "text": "1-c, 2-a, 3-b, 4-d", "correct": false}, {"label": "D", "text": "1-d, 2-a, 3-b, 4-c", "correct": true}], "correct_answer": "D. 1-d, 2-a, 3-b, 4-c", "question_images": ["https://image.prepladder.com/content/3CrOz8CNkQxhJ1aIzay91738034076.png", "https://image.prepladder.com/content/ONATCTZpgJWPK3nKm8x31738034293.png", "https://image.prepladder.com/content/Up7DHTKqxH0AphOjysTL1738034360.png", "https://image.prepladder.com/content/nkINAJYXF5oeRnLXr0101738034423.png"], "explanation_images": ["https://image.prepladder.com/content/ioYCworr40Sut4vcWLHb1738034484.png", "https://image.prepladder.com/content/l06XcmGW6jGrFexCpRTh1738034537.png", "https://image.prepladder.com/content/DV6jZ6lCkDrOzHzU6qWD1738034594.png", "https://image.prepladder.com/content/t8d0OCD6Ls0ROSTmynbH1738034645.png", "https://image.prepladder.com/content/E0TE39Vsk6Wz8cOdcpUa1738034700.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:550px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Screws used in Orthopaedics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cortical Screws</strong></p>\n<p><img alt=\"\" data-author=\"Netha Hussain\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Cortical_screw.jpg\" data-tags=\"\" height=\"372\" src=\"https://image.prepladder.com/content/ioYCworr40Sut4vcWLHb1738034484.png\" width=\"163\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Feature a <strong>lower thread depth and a more aggressive pitch </strong>for better engagement in dense <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> bone.</li>\n<li>Commonly used in load-bearing situations for <span class=\"customMeta\" data-dictid=\"e901999ab1169277719729899ebdee\">robust</span> fixation, such as mending fractures in long bones.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cancellous Screws</strong></p>\n<p><img alt=\"\" data-author=\"Netha Hussain\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Cancellous_screw.jpg\" data-tags=\"\" height=\"196\" src=\"https://image.prepladder.com/content/l06XcmGW6jGrFexCpRTh1738034537.png\" width=\"189\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Have a <strong>deeper thread with a wider pitch,</strong> providing better purchase in the <span class=\"customMeta\" data-dictid=\"f2fe04f3c7169277719614074303ec\">porous</span> structure of <span class=\"customMeta\" data-dictid=\"5f96e2a37016927771834373e8902b\">cancellous</span> bone.</li>\n<li>Ideal for use in areas with low bone density, such as vertebral bodies or the extremities of long bones.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Partially threaded <span class=\"customMeta\" data-dictid=\"5f96e2a37016927771834373e8902b\">cancellous</span> screw (Lag screw)</strong></p>\n<p><img alt=\"\" data-author=\"Rasbak\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Lag_screw_%2804%29.jpg\" data-tags=\"\" height=\"264\" src=\"https://image.prepladder.com/content/DV6jZ6lCkDrOzHzU6qWD1738034594.png\" width=\"91\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lag screws are designed to <span class=\"customMeta\" data-dictid=\"c6486470671692777184e25019e1f0\">compress</span> one piece of bone against another, enhancing the stability of the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> reduction.</li>\n<li><strong>Healing Type</strong>: They promote absolute stability, facilitating direct bone <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> rather than <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> through <span class=\"customMeta\" data-dictid=\"e9321290da16927771830865e0eb6e\">callus</span> formation.</li>\n<li>Two types- Cannulated and Non-cannulated.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Herbert Screw</strong></p>\n<p><img alt=\"\" data-author=\"Plaass, Christian &amp; Falck, Christian &amp; Ettinger, Sarah &amp; Sonnow, Lena &amp; Calderone, Franco &amp; Weizbauer, Andreas &amp; Reifenrath, Janin &amp; Claassen, Leif &amp; Waizy, Hazibullah &amp; Daniilidis, Kiriakos &amp; Stukenborg-Colsman, Christina &amp; Windhagen, Henning.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Photograph-showing-the-used-Herbert-type-magnesium-compression-screw-MAGNEZIX-R-CS-32_fig1_321271362\" data-tags=\"\" height=\"141\" src=\"https://image.prepladder.com/content/t8d0OCD6Ls0ROSTmynbH1738034645.png\" width=\"218\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The Herbert screw is a headless <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> screw with <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> threads on one end and <span class=\"customMeta\" data-dictid=\"5f96e2a37016927771834373e8902b\">cancellous</span> threads on the other, designed to create <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> between bones for stability in fractures and nonunions of small bones.</li>\n<li><strong>Tissue Compatibility</strong>: Its fully implanted design minimizes tissue irritation, and the cannulated feature allows precise positioning in areas with minimal tissue coverage.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dynamic Hip Screw</strong></p>\n<p><img alt=\"\" data-author=\"Hajime123\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:DHS_Klinge.jpg\" data-tags=\"\" height=\"102\" src=\"https://image.prepladder.com/content/E0TE39Vsk6Wz8cOdcpUa1738034700.png\" width=\"274\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Can be used to treat <span class=\"customMeta\" data-dictid=\"fae1f940691692777190975910d696\">intertrochanteric</span> fractures.</li>\n<li>Reduces soft tissue <span class=\"customMeta\" data-dictid=\"85cb03377b1692777199d46846ce58\">stripping</span> and blood loss.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/847573.mp3", "video": ""}, {"text": "Which of the following options correctly describes the image given below.", "options": [{"label": "A", "text": "PHILOS plate", "correct": true}, {"label": "B", "text": "RECON plate", "correct": false}, {"label": "C", "text": "LC-DCP plate", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. PHILOS plate", "question_images": ["https://image.prepladder.com/content/YhIxDnzeentfvGbg8TOS1738033749.png"], "explanation_images": ["https://image.prepladder.com/content/L2DTkbtSjegpNhGGh5S51738033811.png", "https://image.prepladder.com/content/W9xiZA7I7EnwuzNccPCh1738033863.png", "https://image.prepladder.com/content/NcU6oQ33qd9rRoS4x7Jn1738033895.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PHILOS plate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RECON plate </strong><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>PHILOS - <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">Proximal</span> <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> <span class=\"customMeta\" data-dictid=\"1f3ac88f5e169277719047640e36bf\">interlocking</span> system</li>\n<li>Fixes <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> fractures.</li>\n<li>Screws are attached to the head of the <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> via PHILOS using the woodpecker method.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reconstruction plates are used for fractures in bones with complex 3D geometry, such as the <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> and <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> humerus.</li>\n<li>Their primary application is for <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> and acetabular fractures.</li>\n<li>They can also be used for fractures of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> (dorsolateral aspect), clavicle, and calcaneus.</li>\n<li>The plates have notches that allow for bending in three dimensions.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Fjalestad T, Iversen P, Hole MØ, Smedsrud M, Madsen JE \" data-hash=\"\" data-license=\"CC 1.0\" data-source=\"https://openi.nlm.nih.gov/detailedresult?img=PMC4247153_12891_2013_Article_2320_Fig1_HTML&amp;query=philos&amp;it=xg&amp;lic=by&amp;req=4&amp;npos=3\" data-tags=\"\" height=\"435\" src=\"https://image.prepladder.com/content/L2DTkbtSjegpNhGGh5S51738033811.png\" width=\"500\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/W9xiZA7I7EnwuzNccPCh1738033863.png\" width=\"500\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/yT9Mqn7Ajs2bBb93jDZF1745057430.mp3", "video": ""}, {"text": "Match the following instruments 1. Dynamic compression plate a) 2. Limited contact Dynamic compression plate b) 3. Locking Plate c) 4. Semi tubular plate d)", "options": [{"label": "A", "text": "1-c, 2-a, 3-d, 4-b", "correct": true}, {"label": "B", "text": "1-a, 2-d, 3-b, 4-c", "correct": false}, {"label": "C", "text": "1-d, 2-c, 3-b, 4-a", "correct": false}, {"label": "D", "text": "1-c, 2-b, 3-a, 4-d", "correct": false}], "correct_answer": "A. 1-c, 2-a, 3-d, 4-b", "question_images": ["https://image.prepladder.com/content/WvKK6MBjiyiL88ASWT8Y1738033114.png", "https://image.prepladder.com/content/6qJhpehQUbNGntEWP7YL1738033232.png", "https://image.prepladder.com/content/JsMLtsEO5v73nXN3azVO1738033282.png", "https://image.prepladder.com/content/MYZmWJvtUHomno9SfLZy1738033349.png"], "explanation_images": ["https://image.prepladder.com/content/lUB0773Y5faY6ZfDciSm1738033399.png", "https://image.prepladder.com/content/4et6fbp4c9D9NhxKcpf21738033464.png", "https://image.prepladder.com/content/pmU2gkzsyiwz5dgkJdjg1738033520.png", "https://image.prepladder.com/content/CoCDcISe02cE2TAHdtcR1738033559.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Plates used for Fractures</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DCP (Dynamic <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">Compression</span> Plate)</strong></p>\n<p><img alt=\"\" data-author='\" Netha Hussain\"' data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Dynamic_compression_plate\" data-tags=\"\" height=\"163\" src=\"https://image.prepladder.com/content/lUB0773Y5faY6ZfDciSm1738033399.png\" width=\"500\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dynamic <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> plates apply <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> to counteract torsional, bending, and <span class=\"customMeta\" data-dictid=\"1a9e83a309169277719859946ca445\">shear</span> forces.</li>\n<li>Compression can be achieved with external tension devices or self-compression holes in the plate.</li>\n<li>Indicated for <span class=\"customMeta\" data-dictid=\"10b0d1c12d16927772018830011368\">type A</span> <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> fractures, <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> or short <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> <span class=\"customMeta\" data-dictid=\"3a5e357f5b1692777186ef94b008d8\">diaphyseal</span> fractures, and <span class=\"customMeta\" data-dictid=\"0dddac147b1692777201460ab59600\">type B</span> fractures after interfragmentary fixation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>LC-DCP (Limited contact dynamic <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> plate)</strong></p>\n<p><img alt=\"\" data-author=\"Xiong, Yan &amp; Zhao, Yu &amp; Xing, Shu &amp; Du, Quan &amp; Sun, Hong &amp; Wang, Zi &amp; Wu, Si &amp; Wang, Ai. \" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/nterface-profiles-for-the-minimum-contact-locking-compression-plate-MC-LCP-and-the_fig4_26671733\" data-tags=\"\" height=\"163\" src=\"https://image.prepladder.com/content/4et6fbp4c9D9NhxKcpf21738033464.png\" width=\"500\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Characterized by less than 50% contact between the plate and the bone, this design helps preserve blood supply and minimizes <span class=\"customMeta\" data-dictid=\"4c8be6d6b716927771948551f98378\">osteoporosis</span> beneath the plate.</li>\n<li>It is suitable for the <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> of fractures in the clavicle, scapula, olecranon, humerus, radius, ulna, pelvis, <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> tibia, and fibula, particularly in <span class=\"customMeta\" data-dictid=\"0d7f443be816927771942413cbb51d\">osteopenic</span> bone for adult patients.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Locking Plate</strong></p>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/pmU2gkzsyiwz5dgkJdjg1738033520.png\" width=\"500\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Used for osteoporotic bones</li>\n<li>Plate of choice for <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> and the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> femur</li>\n<li>Provides a less rigid <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> than non-locking plates, allowing stable motion that promotes <span class=\"customMeta\" data-dictid=\"e9321290da16927771830865e0eb6e\">callus</span> formation and secondary <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> healing.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Semi <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">Tubular</span> Plate</strong></p>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/CoCDcISe02cE2TAHdtcR1738033559.png\" width=\"500\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Primarily for low-stress areas like the <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> and for <span class=\"customMeta\" data-dictid=\"9e7e90693316927772027cba1a6018\">fibula</span> fractures.</li>\n<li><strong>Compression Mechanism</strong> is achieved by <span class=\"customMeta\" data-dictid=\"897ef2d27c16927771861eb7f4726c\">eccentric</span> screw positioning against the side of the screw hole farthest from the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> line.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/seHc8lVQxxiUmqpfxGJb1745057363.mp3", "video": ""}, {"text": "All of the following are associated with syndactyly except?", "options": [{"label": "A", "text": "Apert syndrome", "correct": false}, {"label": "B", "text": "Klippel-Feil syndrome", "correct": false}, {"label": "C", "text": "Cleft hand deformity", "correct": true}, {"label": "D", "text": "Poland’s syndrome", "correct": false}], "correct_answer": "C. Cleft hand deformity", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/AVx5Qu4DFuDu4nAzop9b1738030963.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Syndromes Associated with Syndactyly</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Apert syndrome</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Carpenter syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Poland syndrome</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Klippel-Feil syndrome</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tower shaped head</li>\n<li>Flat occiput</li>\n<li>Bulging eyes</li>\n<li>Prominent jaws</li>\n<li><strong>Syndactyly </strong>of fingers &amp; toes.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tower shaped head</li>\n<li>Flat occiput</li>\n<li>Bulging eyes</li>\n<li>Prominent jaws</li>\n<li><strong>Syndactyly</strong></li>\n<li>Polydactyly</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Syndactyly</strong></li>\n<li>Hypoplasia of <span class=\"customMeta\" data-dictid=\"0bc1ae5070169277720193a2852d9c\">upper limb</span> girdle</li>\n<li>Brachydactyly</li>\n<li>Symphalangism</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Scoliosis</li>\n<li>Renal abnormalities like <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> agenesis</li>\n<li>Sprengel deformity</li>\n<li>Deafness</li>\n<li>Congenital heart disease</li>\n<li><strong>Syndactyly</strong></li>\n<li>Thumb hypoplasia</li>\n<li>Extra digits</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zYbW28hkXm6fMS0sFjWE1745758357.mp3", "video": ""}, {"text": "During gait analysis, a patient is observed in the stance phase of their gait cycle. Which of the following events is NOT part of the stance phase?", "options": [{"label": "A", "text": "Heel strike", "correct": false}, {"label": "B", "text": "Mid stance", "correct": false}, {"label": "C", "text": "Push off", "correct": false}, {"label": "D", "text": "Acceleration", "correct": true}], "correct_answer": "D. Acceleration", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/xLw7kIcbHWEdBXf8QX8K1738032487.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stance phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Swing phase</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The foot is on the ground.</li>\n<li>Begins with a <strong>heel strike</strong> and ends with a <strong>toe-off</strong>.</li>\n<li>Events:\n\t\t\t\t<ul>\n<li><strong>Heel strike:</strong> Heel contacts the ground. <strong>(Option A)</strong></li>\n<li><strong>Mid stance:</strong> Foot is flat on the ground. <strong>(Option B)</strong></li>\n<li><strong>Toe off:</strong> The body is propelled; the heel rises followed by the toes leaving the ground. <strong>(Option C)</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The foot is off the ground.</li>\n<li>Begins with the <strong>toe off</strong> and ends just before the <strong>heel strike</strong>.</li>\n<li>Events:\n\t\t\t\t<ul>\n<li><strong>Acceleration:</strong> Leg moves forward using hip flexors.</li>\n<li><strong>Mid swing:</strong> Middle of the swinging leg's movement.</li>\n<li><strong>Deceleration:</strong> Swinging leg slows down in preparation for heel strike.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/kOlxlV8ACpTWAlW2Fhr01745048665.mp3", "video": ""}, {"text": "A 30 y/o woman presents with a triggering sensation and pain in her right thumb. She has undergone two steroid injections spaced one month apart without significant relief and has used a splint for 10 weeks. O/E, her thumb is irreducibly locked in a flexed position. Considering her condition and treatment history, what is the most appropriate management option at this stage?", "options": [{"label": "A", "text": "Continue conservative management with NSAIDs and splinting.", "correct": false}, {"label": "B", "text": "Administering a third steroid injection.", "correct": false}, {"label": "C", "text": "Perform percutaneous release of the A1 pulley.", "correct": false}, {"label": "D", "text": "Proceed with open A1 pulley release surgery.", "correct": true}], "correct_answer": "D. Proceed with open A1 pulley release surgery.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Trigger Finger Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non- operative</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>NSAIDs:</strong> Used for pain relief and reducing inflammation</li>\n<li><strong>Steroid Injections:</strong>\n<ul>\n<li>Effective initial treatment, especially in the early stages.</li>\n<li>It is cost-effective and provides quick relief.</li>\n<li>However, it is often only a temporary solution.</li>\n</ul>\n</li>\n<li><strong>Splinting:</strong>\n<ul>\n<li>Blocks <span class=\"customMeta\" data-dictid=\"c208204e741692777192d05da0b9cd\">MCP</span> joint at 10-15° <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> for 6-10 weeks.</li>\n<li>Suitable for early-stage cases but less effective for severe or prolonged symptoms.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Indications for Surgery:</strong>\n<ul>\n<li>Failure of non-surgical treatments (steroid injections, splinting).</li>\n<li>Irreducibly locked trigger finger.</li>\n<li>Congenital trigger thumb with <span class=\"customMeta\" data-dictid=\"68bb58b11016927772035ee8350def\">fixed flexion</span> deformity.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Open A1 Pulley Release:</strong>\n<ul>\n<li>Gold standard; success rates up to 97%.</li>\n<li>Recommended for advanced cases and those unresponsive to conservative methods.</li>\n</ul>\n</li>\n<li><strong>Percutaneous Release:</strong>\n<ul>\n<li>Effective but riskier for thumb due to proximity of digital nerve.</li>\n<li>Less favourable for index, middle, or ring fingers due to higher failure rates.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/IvZGpr96h9vyGEhBnIJC1745758471.mp3", "video": ""}, {"text": "A 45 y/o female presents with a catching sensation in her right ring finger and mild tenderness over the A1 pulley. Upon examination, she can actively extend the digit without assistance. Which of the following grades of Green’s Classification of Trigger Finger best describes her condition?", "options": [{"label": "A", "text": "Grade I", "correct": false}, {"label": "B", "text": "Grade II", "correct": true}, {"label": "C", "text": "Grade III", "correct": false}, {"label": "D", "text": "Grade IV", "correct": false}], "correct_answer": "B. Grade II", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade I: Pain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pain or <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> over the A1 pulley. <strong>(Option A)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade II: Catching </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Catching sensation, but the patient can actively extend the digit.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade III: Locking</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>IIIA:</strong> Demonstrable catching that requires a <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> extension.</li>\n<li><strong>IIIB:</strong> Inability to actively <span class=\"customMeta\" data-dictid=\"73eb6a06aa1692777202a9f27fafa2\">flex</span> the finger. <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade IV: Fixed</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fixed <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> <span class=\"customMeta\" data-dictid=\"3c13e3c8e91692777185822d4393f9\">contracture</span> of the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joint. <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/0FooIGiJnuDsI90ySbk01745046456.mp3", "video": ""}, {"text": "A 45 y/o woman presents to the clinic with pain and stiffness in her right ring finger, which occasionally gets stuck in a flexed position. She has a history of diabetes and notes that the symptoms have worsened over the past few months. Which of the following conditions is most likely contributing to this patient’s symptoms?", "options": [{"label": "A", "text": "Tendon rupture", "correct": false}, {"label": "B", "text": "Trigger finger", "correct": true}, {"label": "C", "text": "Osteoarthritis", "correct": false}, {"label": "D", "text": "Carpal tunnel syndrome", "correct": false}], "correct_answer": "B. Trigger finger", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ZSNLzRXOtFMqHY01fUlW1738032089.png", "https://image.prepladder.com/content/z5ieAEK35tOWrU9TruTT1738032166.png", "https://image.prepladder.com/content/KqH7Mpa2JVT1EIgrVrDX1738032198.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/eXgf8bBmsUcypTJlUhA81745046229.mp3", "video": ""}, {"text": "A 40 y/o female presents with pain in her lower back and hips. She mentions that the pain worsens when she walks or moves. The physician performs a test where she lies supine on the table, and one of her hips is extended while the other knee is flexed to stabilize the pelvis. She experiences significant pain during this manoeuvre. Which test was performed to assess for sacroiliac joint involvement?", "options": [{"label": "A", "text": "Fleche test", "correct": false}, {"label": "B", "text": "Wall test", "correct": false}, {"label": "C", "text": "Gaenslen’s test", "correct": true}, {"label": "D", "text": "Schober test", "correct": false}], "correct_answer": "C. Gaenslen’s test", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ox1WaVz9MaTbTZgEINnr1738031933.png", "https://image.prepladder.com/content/w2Svm3JilLOKjNFKdCsm1738031968.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tests for <span class=\"customMeta\" data-dictid=\"aabbc63449169277718277060e8642\">Ankylosing spondylitis</span> (AS)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wall Test</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Used to assess <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> extension limitations.</li>\n<li>The patient stands with their back against a wall, attempting to touch their heels, buttocks, scapulae, and the back of the head (occiput) to the wall.</li>\n<li>Difficulty in touching all these points simultaneously indicates a reduction in <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> extension, a common finding in AS.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Schober Test</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Measures the <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> of the <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> spine.</li>\n<li>Two marks are placed on the patient's back: one at the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> superior <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> spine level and another 10 cm above it.</li>\n<li>The patient <span class=\"customMeta\" data-dictid=\"247e7aa0181692777182e46b52832d\">bends</span> forward, and the increase in distance between the two marks is measured. A small increase in distance suggests <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> flexion, which is a characteristic of AS.</li>\n</ul>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/ox1WaVz9MaTbTZgEINnr1738031933.png\" width=\"500\"/></p>\n<p><strong>Schober test</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gaenslen’s Test</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Assesses <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joint involvement, which is frequently affected in AS.</li>\n<li>The patient lies on their back, with one hip and knee flexed to stabilize the pelvis. The other hip is then hyperextended over the edge of the table.</li>\n<li><strong>If this manoeuvre exerts rotational strain over the <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joint, causing pain. It indicates <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> or <span class=\"customMeta\" data-dictid=\"3a74ed0fcf16927771901a79847565\">irritation</span> of the <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joint.</strong></li>\n</ul>\n<p><img alt=\"\" data-author=\"Buchanan, Patrick &amp; Vodapally, Shashank &amp; Lee, David &amp; Hagedorn, Jonathan &amp; Bovinet, Christopher &amp; Strand, Natalie &amp; Sayed, Dawood &amp; Deer, Timothy.\" data-hash=\"\" data-license=\"CC BY NC 4.0\" data-source=\"https://www.researchgate.net/figure/Gaenslen-Test-While-stabilizing-a-patients-flexed-knee-a-counter-force-depicted-by_fig3_355148285\" data-tags=\"\" height=\"499\" src=\"https://image.prepladder.com/content/w2Svm3JilLOKjNFKdCsm1738031968.png\" width=\"500\"/></p>\n<p><strong>Gaenslen test</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Straight Leg Raising Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Though primarily used to assess <span class=\"customMeta\" data-dictid=\"2d710fe8461692777191d18505790c\">lumbosacral</span> root tension, this test can also help in identifying <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joint issues.</li>\n<li>The patient lies <span class=\"customMeta\" data-dictid=\"b0976ea1fd16927771995d5c700a21\">supine</span> and is asked to lift one leg with the knee extended. Pain occurring during this test can be due to involvement of the <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joint in AS.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pump-handle Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Another test that evaluates <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joint pain.</li>\n<li>The patient lies on their back, and the examiner fully flexes the hip and knee of one leg. The knee is then forced towards the opposite shoulder, placing pressure on the <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joint.</li>\n<li>Pain <span class=\"customMeta\" data-dictid=\"3978e9614f1692777200abbe4cfa34\">triggered</span> by this movement indicates <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joint <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> or dysfunction, common in AS.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fleche Test</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Designed to detect early involvement of the <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> spine in AS.</li>\n<li>The patient stands with their back against the wall and attempts to touch the back of their head to the wall without lifting their chin.</li>\n<li>The inability to do so suggests <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> spine mobility, which can be an early sign of AS affecting the upper spine.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/pPhIqqwWzX42HDVZcgHm1745045730.mp3", "video": ""}, {"text": "A 28-year-old male presents with chronic low back pain and stiffness that improves with activity but worsens with rest. He has difficulty maintaining a straight posture and shows limited spinal extension on examination. Imaging reveals sacroiliitis. What is the most appropriate initial treatment to manage his symptoms?", "options": [{"label": "A", "text": "Joint replacement", "correct": false}, {"label": "B", "text": "Diclofenac", "correct": true}, {"label": "C", "text": "TNF Inhibitors", "correct": false}, {"label": "D", "text": "Spinal immobilisation", "correct": false}], "correct_answer": "B. Diclofenac", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5k6Y7O7dZ1y1d5Gk2IJE1745045302.mp3", "video": ""}, {"text": "A 28-year-old female presents with four months of lower back pain that improves with activity but worsens with rest. She has limited lumbar motion and reduced chest expansion. Imaging shows grade 2 sacroiliitis bilaterally. Based on the Modified New York Criteria for ankylosing spondylitis, what is the most appropriate conclusion?", "options": [{"label": "A", "text": "The patient meets the criteria for ankylosing spondylitis.", "correct": true}, {"label": "B", "text": "The patient does not meet the criteria for ankylosing spondylitis due to insufficient clinical manifestations.", "correct": false}, {"label": "C", "text": "The patient meets the criteria for ankylosing spondylitis but requires further testing.", "correct": false}, {"label": "D", "text": "The patient likely has a different condition unrelated to ankylosing spondylitis.", "correct": false}], "correct_answer": "A. The patient meets the criteria for ankylosing spondylitis.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/uu1JtisZDffIZFcv338n1745045199.mp3", "video": ""}, {"text": "Which of the following is a characteristic X-ray finding in patients with ankylosing spondylitis?", "options": [{"label": "A", "text": "Joint effusion", "correct": false}, {"label": "B", "text": "Squaring of vertebrae", "correct": true}, {"label": "C", "text": "Osteophyte formation", "correct": false}, {"label": "D", "text": "Cartilage loss", "correct": false}], "correct_answer": "B. Squaring of vertebrae", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/uQRBzf8NKBe2mvVDJPao1738031511.png", "https://image.prepladder.com/content/UPxygrmb61v11iIHHxmU1738031568.png", "https://image.prepladder.com/content/QVypH4pxiOcguOM3oB3I1738031628.png", "https://image.prepladder.com/content/SasOhDRV0PWLRBuGbpbX1738031675.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray Findings of <span class=\"customMeta\" data-dictid=\"aabbc63449169277718277060e8642\">Ankylosing Spondylitis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Squaring of <span class=\"customMeta\" data-dictid=\"89cd4b5bf716927772010247b57941\">vertebra</span> and syndesmophytes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bamboo spine appearance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n<p><img alt=\"\" data-author=\"Crespo-Rodríguez, Ana &amp; Sanz, Jesús &amp; Freites Nuñez, Dalifer &amp; Rosales, Zulema &amp; Abasolo, Lydia &amp; Arrazola, Juan.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/a-Syndesmophytes-at-the-anterosuperior-endplate-of-L3-and-L4-vertebrae-thin-arrows-and_fig2_354136900\" data-tags=\"\" height=\"907\" src=\"https://image.prepladder.com/content/uQRBzf8NKBe2mvVDJPao1738031511.png\" width=\"500\"/></p>\n<p>Squaring of <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> vertebral margins due to <span class=\"customMeta\" data-dictid=\"dc4ced4b86169277719422ad2689a5\">osteitis</span> of <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> corners.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p><img alt=\"\" data-author=\"Gaillard F, Niknejad M, Fahrenhorst-Jones T, et al. \" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/bamboo-spine-ankylosing-spondylitis\" data-tags=\"\" height=\"602\" src=\"https://image.prepladder.com/content/UPxygrmb61v11iIHHxmU1738031568.png\" width=\"500\"/></p>\n<p>Diffuse syndesmophytic ankylosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dagger spine </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sacroiliitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n<p><img alt=\"\" data-author=\"Gaillard F, Feger J, Niknejad M, et al.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/dagger-sign-spine\" data-tags=\"\" height=\"665\" src=\"https://image.prepladder.com/content/QVypH4pxiOcguOM3oB3I1738031628.png\" width=\"500\"/></p>\n<ul>\n<li>Seen only in <span class=\"customMeta\" data-dictid=\"603878db1116927771812fecb63aec\">AP</span> view</li>\n<li>Linear <span class=\"customMeta\" data-dictid=\"3be8c9fc131692777194e15d6aeef3\">ossification</span> of the <span class=\"customMeta\" data-dictid=\"ecfea7a9d416927771908bfc754ecd\">interspinous</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> in the central spine.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n<p><img alt=\"\" data-author=\"Servet Kahveci\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/sacroiliitis-5\" data-tags=\"\" height=\"997\" src=\"https://image.prepladder.com/content/SasOhDRV0PWLRBuGbpbX1738031675.png\" width=\"500\"/></p>\n<ul>\n<li>Bilateral <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joint erosions and sclerosis.</li>\n<li>Joint is ill-defined bilaterally.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><strong>The \"trolley-track sign\" </strong>occurs due to the <span class=\"customMeta\" data-dictid=\"3be8c9fc131692777194e15d6aeef3\">ossification</span> of the ligaments along with the apophyseal joint capsules, resulting in three vertical <span class=\"customMeta\" data-dictid=\"418c408a7716927771979034974902\">radiodense</span> lines visible on <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> imaging.</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features of <span class=\"customMeta\" data-dictid=\"aabbc63449169277718277060e8642\">Ankylosing Spondylitis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset and Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Established Disease Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Postural Changes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Commonly begins in young adults, typically between ages 15-25.</li>\n<li>More prevalent in males than females.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Insidious onset of chronic back pain and stiffness.</li>\n<li>Morning <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> lasting over an hour and <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> after inactivity.</li>\n<li>Possible <span class=\"customMeta\" data-dictid=\"047f8930dd1692777197fed61e213c\">referred</span> pain in the <span class=\"customMeta\" data-dictid=\"a0af4564cf1692777183e503d226f6\">buttocks</span> and thighs, sometimes confused with sciatica.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Continuous pain and stiffness</li>\n<li>General fatigue.</li>\n<li>Joint pain and swelling.</li>\n<li>Tenderness at the <span class=\"customMeta\" data-dictid=\"a6866cebd81692777180cccaabbb81\">Achilles tendon</span> insertion.</li>\n<li>Intercostal pain and tenderness.</li>\n<li>Decreased chest expansion</li>\n<li>Enthesitis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reduced <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> <span class=\"customMeta\" data-dictid=\"45114cc1d5169277719137b6fba061\">lordosis</span> (normal inward curve of the lower back).</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> <span class=\"customMeta\" data-dictid=\"67deccee6a16927771911e0dcd1c3c\">kyphosis</span> (outward curve of the upper back).</li>\n<li>Forward <span class=\"customMeta\" data-dictid=\"00435dfd7d16927772003372024ddb\">thrust</span> of the neck, with <span class=\"customMeta\" data-dictid=\"8c77461be01692777184e67e678209\">compensatory</span> hip and knee flexion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extraarticular</strong></p>\n<p><strong>manifestations </strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uveitis, <span class=\"customMeta\" data-dictid=\"59a120854e16927771820318aebd4a\">aortic valve</span> disease, carditis, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> fibrosis, osteoporosis, <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease, psoriasis, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> abnormalities</p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n<p><strong>References:</strong></p>\n<ul><li>↳ Apley and Solomon’s System of Orthopaedics and Trauma, 10th Edition, Page 4, 18, 72, 73, 74, 485</li><li>↳ Extra-articular manifestations of ankylosing spondylitis .</li><li>↳ Ankylosing spondylitis | Radiology Reference Article</li><li>↳ Trolley-track sign</li></u\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/1Wh4NzC4whww5nE2n3SG1745044406.mp3", "video": ""}, {"text": "A 22 y/o male presents with chronic lower back pain and stiffness, especially in the mornings, which improves with activity. He also mentions discomfort in the pelvic region. He is HLA-B27 positive. Based on the findings, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Ankylosing Spondylitis", "correct": true}, {"label": "B", "text": "Rheumatoid Arthritis", "correct": false}, {"label": "C", "text": "Osteoarthritis", "correct": false}, {"label": "D", "text": "Gout", "correct": false}], "correct_answer": "A. Ankylosing Spondylitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ankylosing Spondylitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Genetic association:</strong> Strong <span class=\"customMeta\" data-dictid=\"5dda3cc2ab1692777202b3b3c65bea\">familial</span> link; more common in relatives of AS patients.</li>\n<li><strong>HLA-B27:</strong> Over 95% of Caucasian AS patients are <strong>positive</strong> for this genetic marker, its <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> correlates with AS <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> in different racial groups.</li>\n<li><strong>Triggering factors:</strong>\n<ul>\n<li>Antibody response to a bacterial <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> may cross-react with HLA-B27 positive cells.</li>\n<li>HLA-B27 may present specific antigens to T-cells, triggering an immune response.</li>\n<li>Infections (genitourinary, bowel) may contribute through <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> spread.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>AS is a <span class=\"customMeta\" data-dictid=\"676cb5b15c16927771987d192e19d6\">seronegative</span> spondyloarthropathy.</strong></li>\n<li><strong>Synovitis:</strong> <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">Inflammation</span> of <span class=\"customMeta\" data-dictid=\"eaa3883838169277718638c577ad05\">diarthrodial</span> joints (sacroiliac, vertebral), causing <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> and bone destruction.</li>\n<li>It is associated with <span class=\"customMeta\" data-dictid=\"6dfb2b0c981692777200eae81482e9\">TNF</span> alpha, IL-6, IL-17.</li>\n<li><strong>Enthesopathy:</strong> <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">Inflammation</span> at <span class=\"customMeta\" data-dictid=\"e301bf525b1692777202e8e0c0a3d6\">fibro-osseous</span> junctions, affecting ligaments, tendons, and <span class=\"customMeta\" data-dictid=\"95a8e326831692777190c5101eb835\">intervertebral</span> discs.</li>\n<li><strong>Stages of progression:</strong>\n<ul>\n<li>Inflammation with <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> infiltration.</li>\n<li>Fibrosis replacing <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue.</li>\n<li>Ossification leads to <span class=\"customMeta\" data-dictid=\"48598b4ac316927771818ed58a2b5e\">ankylosis</span> (joint fusion).</li>\n</ul>\n</li>\n<li><strong>Syndesmophytes:</strong> Bony bridges between vertebrae, leading to a \"bamboo spine\" in severe cases.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/c8naJu89pPLkS9nu2VcV1745044324.mp3", "video": ""}, {"text": "A 2 y/o child presents with complete syndactyly of the third and fourth fingers. The web space between the digits is absent, and the fusion involves both skin and bone. The surgeon plans to perform a surgical separation. Which of the following techniques is most appropriate to avoid scar contractures during the procedure?", "options": [{"label": "A", "text": "A straight incision along the digits", "correct": false}, {"label": "B", "text": "Zigzag incision for skin separation", "correct": true}, {"label": "C", "text": "Only dorsal incisions with no volar involvement", "correct": false}, {"label": "D", "text": "Single-stage separation of both radial and ulnar sides of the digits", "correct": false}], "correct_answer": "B. Zigzag incision for skin separation", "question_images": ["https://image.prepladder.com/content/SUvwsEdtuFdq5KkUNN8Q1738031178.png"], "explanation_images": ["https://image.prepladder.com/content/RNJIYWKO7DCtR2ABxsre1738031250.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/YRb8soIMmqKz9UsAGtXo1745044201.mp3", "video": ""}, {"text": "A newborn presents with the fusion of the third and fourth fingers, with X-rays showing both bone and soft tissue involvement along the entire length of the digits. What classification of syndactyly does this represent?", "options": [{"label": "A", "text": "Simple complete syndactyly", "correct": false}, {"label": "B", "text": "Simple incomplete syndactyly", "correct": false}, {"label": "C", "text": "Complex complete syndactyly", "correct": true}, {"label": "D", "text": "Complex incomplete syndactyly", "correct": false}], "correct_answer": "C. Complex complete syndactyly", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/snEGfcAk4IqFP6ssaxSe1738031094.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Syndactyly Classification</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Simple Syndactyly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Only soft tissue is fused</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complex Syndactyly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Both skin and bone are fused</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complete Syndactyly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Webbing along the entire length of affected digits</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Incomplete Syndactyly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Webbing along only part of the length of the affected digits.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complicated Syndactyly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Accessory Phalanages or <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> bones involved in fusion.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/snEGfcAk4IqFP6ssaxSe1738031094.png\" width=\"500\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/2DXPbJ62nWraHpczl9Im1745044006.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 34 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 1</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Images And Instruments-Previous Year Questions - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 1</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 1 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Identify the instrument:", "options": [{"label": "A", "text": "Bohler braun splint", "correct": true}, {"label": "B", "text": "Thomas splint", "correct": false}, {"label": "C", "text": "Volkmann splint", "correct": false}, {"label": "D", "text": "Cramer wire", "correct": false}], "correct_answer": "A. Bohler braun splint", "question_images": ["https://image.prepladder.com/content/VIPn9QRNyw9mbPcPCZA91741089331.png"], "explanation_images": ["https://image.prepladder.com/content/mGhcVlckSObxqQzakuBt1741059431.png", "https://image.prepladder.com/content/Q9DnAAi5h5lJsf4Xl2RM1741059475.png", "https://image.prepladder.com/content/sgL0lzIaDQy9ZSZjuowe1741059546.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 11 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 53</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Lower Limb Traumatology-Previous Year Questions - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 53</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 53 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A young man is brought to the emergency department following a road traffic accident. He was driving the car when the accident occurred. On examination, it is noted that the injured leg is shortened. The image of the pelvis radiograph is shown below. Which of the following nerves is most commonly injured in the given condition?", "options": [{"label": "A", "text": "Sciatic nerve", "correct": true}, {"label": "B", "text": "Posterior femoral cutaneous nerve", "correct": false}, {"label": "C", "text": "Inferior gluteal nerve", "correct": false}, {"label": "D", "text": "Superior gluteal nerve", "correct": false}], "correct_answer": "A. Sciatic nerve", "question_images": ["https://image.prepladder.com/content/kuXN5UZvn3tiJ2e9eG3O1746014661.png"], "explanation_images": ["https://image.prepladder.com/content/2O92YI4o3wyQgDSA8kUo1746014700.png", "https://image.prepladder.com/content/P4daVjkN47O0lI1RLTdn1746014700.png", "https://image.prepladder.com/content/HEZHlTFAagT384K9zfsm1746014700.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Posterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Anterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Central <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of injury:</strong><br/>\n\t\t\tCaused by force along the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> with the hip flexed (e.g., <strong>dashboard injury </strong>in motor accidents).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of injury:</strong></p>\n<p>Rare injury that occurs with forced <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> and external rotation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of injury: </strong></p>\n<p>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head is driven through the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> wall of the <span class=\"customMeta\" data-dictid=\"58112da05c1692777180028ce828fa\">acetabulum</span> into the <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> cavity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features:</strong></p>\n<ul>\n<li>History of trauma.</li>\n<li>Pain, swelling.</li>\n<li>Deformity: <strong>flexion</strong>, <strong>adduction</strong>, <strong>internal rotation</strong>.</li>\n<li><strong>Shortening </strong>of the leg.</li>\n<li><strong>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head is </strong>palpable in the <strong>gluteal </strong>region.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features: </strong></p>\n<ul>\n<li>The limb appears <strong>externally rotated.</strong></li>\n<li>Possible <strong>lengthening of the affected limb </strong></li>\n<li><strong>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head </strong>is <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> in the <strong>groin</strong>.</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features:</strong></p>\n<ul>\n<li>Varying <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> is seen.</li>\n<li>Joint <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> and <span class=\"customMeta\" data-dictid=\"720567fecd169277719411dda3d1a2\">osteoarthritis</span> are very likely.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nerve injury: <strong>common</strong>, <strong>sciatic nerve</strong> is injured.</li>\n<li>Arterial injury: rare</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nerve injury: rare</li>\n<li><strong>Arterial injury:</strong> relatively more <strong>common</strong>, <strong>Femoral artery</strong> is injured</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Hip_dislocation#/media/File:HipdisX.png\" data-tags=\"\" height=\"506\" src=\"https://image.prepladder.com/content/2O92YI4o3wyQgDSA8kUo1746014700.png\" width=\"347\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Lorenzo Ceri, Luigi Zanna, Roberto Buzzi, Pietro De Biase\" data-hash=\"\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.sciencedirect.com/science/article/pii/S235264402100056X?via%3Dihub\" data-tags=\"\" height=\"355\" src=\"https://image.prepladder.com/content/P4daVjkN47O0lI1RLTdn1746014700.png\" width=\"363\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Samir Benoudina\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/central-fracture-dislocation-of-the-acetabulum-2\" data-tags=\"\" height=\"388\" src=\"https://image.prepladder.com/content/HEZHlTFAagT384K9zfsm1746014700.png\" width=\"310\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For which type of fractures does the Hawkins classification apply?", "options": [{"label": "A", "text": "Tibia", "correct": false}, {"label": "B", "text": "Humerus", "correct": false}, {"label": "C", "text": "Talus", "correct": true}, {"label": "D", "text": "Calcaneus", "correct": false}], "correct_answer": "C. Talus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Undisplaced <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of the talar neck.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Displaced <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> with <span class=\"customMeta\" data-dictid=\"e53b153fb316927771996481a3e88f\">subluxation</span> or <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of the <span class=\"customMeta\" data-dictid=\"1d205eb28916927771997a96a2124f\">subtalar</span> joint.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Displaced <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> with <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of the <span class=\"customMeta\" data-dictid=\"ee55b45c5f1692777200dd3dd0256a\">talus</span> body from the ankle joint.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Displaced vertical talar neck <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> with associated <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> of the <span class=\"customMeta\" data-dictid=\"1d4313808f1692777200ecb48a2328\">talonavicular</span> joint.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The radiograph below depicts a patient who is experiencing persistent knee pain without any previous injury. Identify the specific condition displayed in the image?", "options": [{"label": "A", "text": "Patellar avulsion fracture, TBW", "correct": false}, {"label": "B", "text": "Bipartite patella, X-ray of the opposite knee", "correct": true}, {"label": "C", "text": "Fracture of the upper pole of the patella, Cylindrical cast", "correct": false}, {"label": "D", "text": "Avulsion fracture, interfragmentary screw fixation", "correct": false}], "correct_answer": "B. Bipartite patella, X-ray of the opposite knee", "question_images": ["https://image.prepladder.com/content/4CsgBuDRS3PPilrrxDZn1745301681.png"], "explanation_images": ["https://image.prepladder.com/content/DCOgcJ20zhWyAhni8vMs1745301724.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> condition where the <span class=\"customMeta\" data-dictid=\"615557ed3a169277719497f86e830b\">patella</span> (kneecap) is divided into two separate bone segments.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Failure of <span class=\"customMeta\" data-dictid=\"3be8c9fc131692777194e15d6aeef3\">ossification</span> centers to <span class=\"customMeta\" data-dictid=\"30bdb5481f1692777203cbadf50a71\">fuse</span> during development, resulting in separate bone fragments.</li>\n<li>Occurs in approximately 1-2% of the population, often bilateral.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anatomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Typically involves the <span class=\"customMeta\" data-dictid=\"372f8a661016927771993a9755d398\">superolateral</span> corner of the patella.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Based on the location of the secondary <span class=\"customMeta\" data-dictid=\"3be8c9fc131692777194e15d6aeef3\">ossification</span> centre,</p>\n<ul>\n<li>Type I: Inferior pole of patella.</li>\n<li>Type II: <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> margin.</li>\n<li>Type III: <span class=\"customMeta\" data-dictid=\"372f8a661016927771993a9755d398\">Superolateral</span> (most common).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usually asymptomatic, but can cause <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> knee pain, especially after trauma or repetitive stress.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>X-ray: Shows the <span class=\"customMeta\" data-dictid=\"615557ed3a169277719497f86e830b\">patella</span> with a well-corticated fragment.</p>\n<p>MRI: Useful for assessing associated soft tissue injury or bone <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> if symptomatic.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Patellar <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> (differs by smooth, rounded edges in <span class=\"customMeta\" data-dictid=\"fbe4520a1316927771830df0903b72\">bipartite</span> <span class=\"customMeta\" data-dictid=\"615557ed3a169277719497f86e830b\">patella</span> vs sharp edges in fractures).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Asymptomatic: No treatment required.</li>\n<li>Symptomatic: Rest, NSAIDs, physical therapy, or in severe cases, surgery (excision of fragment).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a child brought to the orthopedics OPD with a lower limb deformity and hyperpigmented skin lesions, based on the presented X-ray of her thigh?", "options": [{"label": "A", "text": "Non-ossifying fibroma", "correct": false}, {"label": "B", "text": "Fibrous dysplasia", "correct": true}, {"label": "C", "text": "Paget's disease", "correct": false}, {"label": "D", "text": "Osteogenesis imperfecta", "correct": false}], "correct_answer": "B. Fibrous dysplasia", "question_images": ["https://image.prepladder.com/content/NqDjWX9ja3OejA6EOY6E1745302008.png"], "explanation_images": ["https://image.prepladder.com/content/GERUYHAlqry44iDPSeF01745302063.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Non-inherited developmental disorder causing replacement of bone by <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> tissue</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>GNAS1</strong> gene <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> (Chromosome 20)</li>\n<li>Associated with <strong>McCune Albright syndrome - Polyostotic <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">Fibrous</span> Dysplasia</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Usually presents in the 2nd decade</li>\n<li>Progressive limb pain, swelling</li>\n<li>Limb deformities with associated fractures</li>\n<li><strong>Skin lesions (seen with McCune Albright syndrome)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>X-ray: well defined expansile <span class=\"customMeta\" data-dictid=\"5b22285eec169277719026820db11c\">intramedullary</span> lesions with ‘<strong>Ground glass</strong>’ appearance, <strong>‘shepherd crook deformity’</strong>.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ian Bickle\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/shepherd-crook-deformity-polyostotic-fibrous-dysplasia\" data-tags=\"\" height=\"402\" src=\"https://image.prepladder.com/content/GERUYHAlqry44iDPSeF01745302063.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>MRI: is done to know the full extent of the disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Medical: <strong>Bisphosphonates</strong></li>\n<li>Surgical: <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">Deformity</span> <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> surgeries</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the likely diagnosis based on the x-ray image of a 22-year-old female?", "options": [{"label": "A", "text": "Chondroblastoma", "correct": false}, {"label": "B", "text": "Osteochondroma", "correct": false}, {"label": "C", "text": "Giant cell tumor", "correct": true}, {"label": "D", "text": "Aneurysmal bone cyst", "correct": false}], "correct_answer": "C. Giant cell tumor", "question_images": ["https://image.prepladder.com/content/1nADr6lpgeemZJBulW2T1745302870.png"], "explanation_images": ["https://image.prepladder.com/content/q5XwsfmaNT0yNAZ4Ehl01745302952.png", "https://image.prepladder.com/content/YVbWup8izR975xIjCJCb1745302952.png", "https://image.prepladder.com/content/W14h9nWIeHxvr2gcwkhb1745302952.png", "https://image.prepladder.com/content/B33jyIElnN4rSCDXgvwx1745302952.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Benign but locally aggressive tumor of bone.<strong> </strong></li>\n<li>It commonly arises from epiphysis.</li>\n<li>MC Age: 20 and 45 years of age.</li>\n<li>Females &gt; males.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sites affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Distal <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> &gt; <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> &gt; <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> &gt; sacrum.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Malignant transformation in &lt;1% of cases.</li>\n<li>Lungs are the most common site for metastases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Swelling, vague pain.</li>\n<li>Pathological fracture.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>X-ray: Expansile <span class=\"customMeta\" data-dictid=\"897ef2d27c16927771861eb7f4726c\">eccentric</span> <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> on epiphysis</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Andreas F Mavrogenis, Vasilios Igoumenou, Panayiotis D. Megaloikonomos, Georgios N. Panagopoulos, Panayiotis J Papagelopoulos, Panayotis N. Soucacos\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Campanacci-et-al-3-grading-system-for-GCT-that-is-based-on-the-radiographic-appearance_fig1_319707094\" data-tags=\"\" height=\"385\" src=\"https://image.prepladder.com/content/q5XwsfmaNT0yNAZ4Ehl01745302952.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Extended <span class=\"customMeta\" data-dictid=\"f857ee35331692777185a5895e53b5\">curettage</span> with Bone grafting</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old patient has limited hip movement and complains of pain and discomfort in the hip region. Which of the following tests is done to identify flexion deformity at the hip?", "options": [{"label": "A", "text": "Thomas test", "correct": true}, {"label": "B", "text": "Lasegue test", "correct": false}, {"label": "C", "text": "Telescopy", "correct": false}, {"label": "D", "text": "McMurray test", "correct": false}], "correct_answer": "A. Thomas test", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 80-year-old woman slipped and fell in the bathroom, experiencing pain and an inability to walk due to a left hip injury, without any prior osteoarthritis history, and with an observation of a shortened and externally rotated left lower limb according to X-ray findings, how would you plan to manage her condition?", "options": [{"label": "A", "text": "Internal fixation with cancellous screws", "correct": false}, {"label": "B", "text": "Meyer's operation", "correct": false}, {"label": "C", "text": "Hemiarthroplasty", "correct": true}, {"label": "D", "text": "McMurray's osteotomy", "correct": false}], "correct_answer": "C. Hemiarthroplasty", "question_images": ["https://image.prepladder.com/notes/st0oL6cm3pZoppHvEy4u1747384488.png"], "explanation_images": ["https://image.prepladder.com/notes/TmHqwxyKhYrjAUFTrzze1747384560.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young male who met with a road traffic accident is brought to the emergency department. His left leg is shortened, internally rotated, and adducted. On examination, femoral artery pulsation is not felt. A plain radiograph of his lower limb was taken which is shown below. What is your diagnosis?", "options": [{"label": "A", "text": "Intertrochanteric fracture of the femur", "correct": false}, {"label": "B", "text": "Fracture neck of femur with injury to femoral vessels", "correct": false}, {"label": "C", "text": "Anterior dislocation of hip with femoral artery injury", "correct": false}, {"label": "D", "text": "Posterior dislocation of hip", "correct": true}], "correct_answer": "D. Posterior dislocation of hip", "question_images": ["https://image.prepladder.com/notes/0rEql9HtkNjpZD7AmOIN1747914651.png"], "explanation_images": ["https://image.prepladder.com/notes/0rEql9HtkNjpZD7AmOIN1747914651.png", "https://image.prepladder.com/notes/lh1ylf1Sw02wyttJjfB81747914712.png", "https://image.prepladder.com/notes/pAYQVP3UXPNhJMMoqSDc1747914763.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:722px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Posterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Anterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Central <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of injury:</strong><br/>\n\t\t\tCaused by force along the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> with the hip flexed (e.g., <strong>dashboard injury </strong>in motor accidents).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of injury:</strong></p>\n<p>Rare injury that occurs with forced <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> and external rotation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of injury: </strong></p>\n<p>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head is driven through the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> wall of the <span class=\"customMeta\" data-dictid=\"58112da05c1692777180028ce828fa\">acetabulum</span> into the <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> cavity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features:</strong></p>\n<ul>\n<li>History of trauma.</li>\n<li>Pain, swelling.</li>\n<li>Deformity: <strong>flexion</strong>, <strong>adduction</strong>, <strong>internal rotation</strong>.</li>\n<li><strong>Shortening </strong>of the leg.</li>\n<li><strong>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head is </strong>palpable in the <strong>gluteal </strong>region.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features: </strong></p>\n<ul>\n<li>The limb appears <strong>externally rotated.</strong></li>\n<li>Possible <strong>lengthening of the affected limb </strong></li>\n<li><strong>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head </strong>is <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> in the <strong>groin</strong>.</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features:</strong></p>\n<ul>\n<li>Varying <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> is seen.</li>\n<li>Joint <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> and <span class=\"customMeta\" data-dictid=\"720567fecd169277719411dda3d1a2\">osteoarthritis</span> are very likely.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nerve injury: <strong>common</strong>, <strong>sciatic nerve</strong> is injured.</li>\n<li>Arterial injury: rare</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nerve injury: rare</li>\n<li><strong>Arterial injury:</strong> relatively more <strong>common</strong>, <strong>Femoral artery</strong> is injured</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"posterior dislocation of the hip.\" data-author=\"James Heilman, MD\" data-hash=\"13179\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Hip_dislocation#/media/File:HipdisX.png\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/0rEql9HtkNjpZD7AmOIN1747914651.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Anterior dislocation of hip\" data-author=\"Lorenzo Ceri, Luigi Zanna, Roberto Buzzi, Pietro De Biase\" data-hash=\"13180\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.sciencedirect.com/science/article/pii/S235264402100056X?via%3Dihub\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/lh1ylf1Sw02wyttJjfB81747914712.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Central fracture dislocation of hip\" data-author=\"Samir Benoudina\" data-hash=\"13181\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/central-fracture-dislocation-of-the-acetabulum-2\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/pAYQVP3UXPNhJMMoqSDc1747914763.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 74-year-old man, who was previously a weightlifter, presented with lower back pain that was radiating to his legs. On examination , a palpable step was felt in the lumbosacral region of the spine. The x-ray of the spine is given below. What is the likely diagnosis?", "options": [{"label": "A", "text": "Spondylolysis", "correct": false}, {"label": "B", "text": "Spondylolisthesis", "correct": true}, {"label": "C", "text": "Disc prolapse", "correct": false}, {"label": "D", "text": "Spondylosis", "correct": false}], "correct_answer": "B. Spondylolisthesis", "question_images": ["https://image.prepladder.com/notes/2tGP5c5jRw8rLUV7cNlD1747915232.png"], "explanation_images": ["https://image.prepladder.com/notes/yQUjNaWdDw4UrtPR3Y4h1747915429.png", "https://image.prepladder.com/notes/6nF45HF8Uf2ckgo5Ko3R1747915526.png", "https://image.prepladder.com/notes/8kFlnYq48Eerw5clMQId1747915575.png", "https://image.prepladder.com/notes/yXITopyApTQOH1KnngPX1747915619.png", "https://image.prepladder.com/notes/9gcFjKdj6VstefxZfFGi1747915674.png", "https://image.prepladder.com/notes/v06r61hU5uQPpaNesGrw1747915739.png", "https://image.prepladder.com/notes/U0FCUEgnl8MqcJrZMgmG1747915816.png", "https://image.prepladder.com/notes/n7UOcoeRhd46uxe8RxqN1747915863.png", "https://image.prepladder.com/content/pU8OQ9RNvQy0EzAzmWey1745837567.png", "https://image.prepladder.com/notes/J5sbwI2OrOnbHt3wPbiv1747915971.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Spondylolisthesis</strong></p>\n<p> </p>\n<p style=\"text-align:center\"><img alt=\"Spondylolisthesis\" data-author=\"\" data-hash=\"13189\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/yQUjNaWdDw4UrtPR3Y4h1747915429.png\"/></p>\n<ul>\n<li>It refers to the forward <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of a <span class=\"customMeta\" data-dictid=\"89cd4b5bf716927772010247b57941\">vertebra</span> over the one beneath it</li>\n<li>Commonly occurring at the L5-S1 and L4-L5 levels.</li>\n<li><strong>Spondylolysis </strong>refers to a<strong> <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in the <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> without</strong> the<strong> <span class=\"customMeta\" data-dictid=\"89cd4b5bf716927772010247b57941\">vertebra</span> slipping forward</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Classification</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Dysplastic\" data-author=\"\" data-hash=\"13190\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/6nF45HF8Uf2ckgo5Ko3R1747915526.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dysplastic </strong></p>\n<ul>\n<li>Least common type</li>\n<li>Caused by <strong>congenital anomalies in the upper <span class=\"customMeta\" data-dictid=\"d7ea5b85641692777198096c6c80c2\">sacrum</span> or L5</strong> arch, facilitating the slip.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Isthmic\" data-author=\"\" data-hash=\"13191\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/8kFlnYq48Eerw5clMQId1747915575.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Isthmic </strong></p>\n<ul>\n<li>The most common type</li>\n<li>Involving a <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> in the <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> interarticularis, which can be further divided into three subtypes:</li>\n</ul>\n<ul>\n<li><strong>Lytic</strong>: A fatigue <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of the <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> interarticularis.</li>\n<li><strong>Intact but elongated</strong>: The <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> interarticularis remains intact but is elongated.</li>\n<li><strong>Acute fracture</strong>: A recent <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of the <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> interarticularis. The <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> causes the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> half of the <span class=\"customMeta\" data-dictid=\"89cd4b5bf716927772010247b57941\">vertebra</span> to slip forward while the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> half remains with the lower vertebra.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Degenerative\" data-author=\"\" data-hash=\"13192\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/yXITopyApTQOH1KnngPX1747915619.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Degenerative </strong></p>\n<ul>\n<li>Results from<strong> long-term <span class=\"customMeta\" data-dictid=\"52e6e2a0a11692777190b145ae5dc0\">intersegmental</span> instability</strong>, where the <strong>pars remains intact,</strong> but degenerative changes in the <span class=\"customMeta\" data-dictid=\"25d29169e3169277720246b37b93ef\">facet</span> joints permit forward slipping.</li>\n<li>Common in older adults, where <span class=\"customMeta\" data-dictid=\"acb259200b16927771908888d1377c\">instability</span> in the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"25d29169e3169277720246b37b93ef\">facet</span> joints due to <span class=\"customMeta\" data-dictid=\"720567fecd169277719411dda3d1a2\">osteoarthritis</span> can lead to displacement, occasionally backwards (retrolisthesis).</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> and neurological issues are rare.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Type IV Traumatic Spondylolisthesis\" data-author=\"\" data-hash=\"13193\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/9gcFjKdj6VstefxZfFGi1747915674.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Traumatic </strong></p>\n<p>This results from<strong> fractures</strong> in other parts of the<strong> bony structure</strong> <strong>rather </strong>than in the<strong> <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> interarticularis.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Pathological\" data-author=\"\" data-hash=\"13194\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/v06r61hU5uQPpaNesGrw1747915739.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathological</strong></p>\n<p>Caused by <strong>generalized</strong> or<strong> <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> bone diseases</strong> that weaken the vertebral articulations.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h3><strong>Normal appearance</strong></h3>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h3><strong>Spondylolysis</strong> <strong>(Option A)</strong></h3>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h3><strong>Spondylolisthesis </strong><strong>(Option B)</strong></h3>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Resembles a<strong> Scottish dog</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Collar Appearance</strong>: Indicates a <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in the <span class=\"customMeta\" data-dictid=\"290782db561692777190e9766fc8ae\">isthmus</span> (pars interarticularis)</li>\n<li>Defect without vertebral displacement</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Separated Head and Neck</strong></li>\n<li>Defect with vertebral displacement</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Normal appearance\" data-author=\"Frank Gaillard\" data-hash=\"13195\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/scottie-dog-sign-spine\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/U0FCUEgnl8MqcJrZMgmG1747915816.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Collar Appearance\" data-author=\"Lucien Monfils\" data-hash=\"13196\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:SpondylolisthesisL5S1.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/n7UOcoeRhd46uxe8RxqN1747915863.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\" Jojo assumed\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Spondylolisthesis.jpg\" data-tags=\"\" height=\"233\" src=\"https://image.prepladder.com/content/pU8OQ9RNvQy0EzAzmWey1745837567.png\" width=\"283\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<h3><img alt=\"Normal appearance\" data-author=\"\" data-hash=\"13197\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/J5sbwI2OrOnbHt3wPbiv1747915971.png\"/></h3>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term used to describe the fracture shown in the image, which occurred due to a fall from a significant height?", "options": [{"label": "A", "text": "Open book fracture", "correct": true}, {"label": "B", "text": "Chauffeur fracture", "correct": false}, {"label": "C", "text": "Malgaigne fracture", "correct": false}, {"label": "D", "text": "Bucket handle fracture", "correct": false}], "correct_answer": "A. Open book fracture", "question_images": ["https://image.prepladder.com/notes/JN1KqVWoNNZkSU19gKYA1747916290.png"], "explanation_images": ["https://image.prepladder.com/notes/JN1KqVWoNNZkSU19gKYA1747916290.png", "https://image.prepladder.com/notes/FRTyE5cWiTQxTeXOKYI51747916418.png", "https://image.prepladder.com/notes/NKvJFFQtSYhQHrm2u3OR1747916514.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type A: Stable (Intact <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> arch)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>A1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Avulsion injury</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>A2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Iliac-wing or <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> fracture</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>A3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transverse <span class=\"customMeta\" data-dictid=\"c5e0f80e7e1692777198edc686a232\">sacrococcygeal</span> fracture</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type B: Partially stable (incomplete <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> of the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> arch)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>B1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Open-book</strong> injury <strong>(external rotation) (Option A)</strong></p>\n<p><img alt=\"Open book fracture of Pelvis\" data-author=\"\" data-hash=\"13200\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/JN1KqVWoNNZkSU19gKYA1747916290.png\"/></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>B2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lateral-compression injury <strong>(internal rotation)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>B2-1:</strong> Ipsilateral <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> injuries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>B2-2:</strong> Contralateral <strong>(bucket-handle)</strong> injuries <strong>(Option D)</strong></p>\n<p> </p>\n<p><img alt=\"Diametric or Bucket Handle Injury.\" data-author=\"\" data-hash=\"13201\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/FRTyE5cWiTQxTeXOKYI51747916418.png\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>B3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bilateral</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type C: Unstable (complete <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> of the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> arch)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>C1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unilateral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>C2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bilateral, with one side type B, one side type C</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>C3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bilateral</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year old female met with an accident and was brought to trauma centre and X-ray pelvis was performed and image is given below shows Intracapsular fracture NOF. What is the management in this case?", "options": [{"label": "A", "text": "Closed reduction", "correct": false}, {"label": "B", "text": "Hemiarthroplasty", "correct": false}, {"label": "C", "text": "Open+ Closed reduction", "correct": false}, {"label": "D", "text": "Open reduction+ Internal fixation", "correct": true}], "correct_answer": "D. Open reduction+ Internal fixation", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/SsAVhhDI3nF88gNfGAVS1741181473.png", "https://image.prepladder.com/content/1G0OVcjFY9UlmQADH0fB1741181480.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:737px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Neck of <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">Femur</span> Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Intertrochanteric Fracture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intracapsular (within the joint capsule)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extracapsular (outside the joint capsule)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically after 50 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically after 60 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Female &gt; Male</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Male &gt; Female</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Patient Demographics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elderly (low-energy trauma like falls)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elderly (low-energy trauma); rare high-energy trauma in younger patients</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trivial, low-energy trauma (osteoporotic)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low-energy trauma in elderly; usually requires significant trauma in younger patients</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stability</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less stable, especially if displaced</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generally unstable due to muscle forces and location</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ability to Walk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May be possible in <span class=\"customMeta\" data-dictid=\"ab375457da16927771891fcf9431da\">impacted</span> fractures</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Walking is not possible due to the instability</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>External <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">Rotation</span> Deformity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less than 45º</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More than 45º</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Shortening</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less than 1 inch</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More than 1 inch</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Supply Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High risk of <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> (medial <span class=\"customMeta\" data-dictid=\"ed0b0613a81692777184dc4b974a19\">circumflex</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disruption)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower risk of <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> necrosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less blood loss due to <span class=\"customMeta\" data-dictid=\"9c6f97404e1692777190f9ed62079f\">intracapsular</span> location</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More blood loss due to the involvement of surrounding <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> structures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pain, Severity, and Tenderness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild to moderate pain <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> to the groin/hip region. <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">Tenderness</span> is typically felt in Scarpa’s triangle.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe pain, more generalized around the hip with marked <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> over the greater trochanter. Weight-bearing is difficult or impossible.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment Options</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Non-displaced:</strong> Internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> <strong>(Option D)</strong> (e.g., cannulated screws)</li>\n<li><strong>Displaced:</strong> <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> (hemiarthroplasty <strong>(Option B ruled out)</strong>, total hip replacement)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Almost always requires internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> (e.g., dynamic hip screws, <span class=\"customMeta\" data-dictid=\"5b22285eec169277719026820db11c\">intramedullary</span> nails)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High risk of <span class=\"customMeta\" data-dictid=\"52a1dd8c4f1692777193dd58a0d51c\">nonunion</span> and <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> necrosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Malunion is more common than nonunion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/SsAVhhDI3nF88gNfGAVS1741181473.png\" width=\"1999\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/1G0OVcjFY9UlmQADH0fB1741181480.png\" width=\"1999\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Arrange the following in the correct sequence for the Thomas test: 1. Squaring of pelvis 2. Flexion of the hip 3. Look for exaggerated lumbar lordosis 4. Measure actual flexion deformity 5.Make sure that the ischial tuberosity makes contact with the ground. 6. Overcorrection of the normal side", "options": [{"label": "A", "text": "1, 2, 3, 4, 5", "correct": false}, {"label": "B", "text": "3, 2, 1, 4, 6", "correct": false}, {"label": "C", "text": "3, 2, 6, 5, 4", "correct": true}, {"label": "D", "text": "3, 6, 2, 5, 4", "correct": false}], "correct_answer": "C. 3, 2, 6, 5, 4", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old patient with a cast, due to tibia fracture, presented to the emergency department with complaints of intense pain. The cast was removed and on physical examination, passive extension of leg was painful. The dorsalis pedis and posterior tibial pulses were present and there was a loss of sensation over the first web space. What is the next step?", "options": [{"label": "A", "text": "Duplex imaging", "correct": false}, {"label": "B", "text": "Re-apply cast", "correct": false}, {"label": "C", "text": "Measure the anterior compartment pressure", "correct": true}, {"label": "D", "text": "Analgesics", "correct": false}], "correct_answer": "C. Measure the anterior compartment pressure", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/F3v8N7aIVJ8hMNMwVoHC1746432230.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "After a fracture in the femoral shaft, your consultant instructs you to apply tibia traction. Which of the following will you ask the nurse to provide? 1. Thomas splint 2. K-wire 3. Steinmann pin 4. Denham's pin 5. Bohler's stirrup 6. Bohler Braun splint", "options": [{"label": "A", "text": "1, 2, 4", "correct": false}, {"label": "B", "text": "3, 5, 6", "correct": true}, {"label": "C", "text": "3, 4, 5", "correct": false}, {"label": "D", "text": "1, 2, 3, 4, 5, 6", "correct": false}], "correct_answer": "B. 3, 5, 6", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/b0nm3x6inNWXVBuy6JMk1745558784.png", "https://image.prepladder.com/content/pOqH3BugIulXiGSvbA1g1745558784.png", "https://image.prepladder.com/content/JKabmY8retyYE6Eq8Lj51745558784.png", "https://image.prepladder.com/content/Wgpp9jkjekkeiaxuZIvM1745558784.png", "https://image.prepladder.com/notes/asyn1Q2qWQ9YnFVpKS181747033447.png", "https://image.prepladder.com/content/2DUEBISPwcnm96iT0vak1745558784.png", "https://image.prepladder.com/content/ZeR0rLE3GK3iBlCiFBQn1745558784.png", "https://image.prepladder.com/content/ahfbuDT7FJz4x0LACgRk1745558784.png", "https://image.prepladder.com/content/yuZ7IMeb4MNFLISiCxOy1745558784.png", "https://image.prepladder.com/notes/xEGWjTpANAsTWHLwmdGN1747033134.png", "https://image.prepladder.com/content/ozcm1PP3TiJjfOG5uVj41745558784.png", "https://image.prepladder.com/notes/0Oy0ULcaDRbGdcFYonve1747033236.png", "https://image.prepladder.com/notes/NBuk0nhS7B2vUBCdLVXD1747033301.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Instrument</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Images</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Proximal <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">Femur</span> Nail (PFN)</strong></p>\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">Proximal</span> <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">Femoral</span> Nail (PFN) is used for closed <span class=\"customMeta\" data-dictid=\"5b22285eec169277719026820db11c\">intramedullary</span> <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> of <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> fractures.</li>\n<li>It features two <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> openings for a <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> neck <span class=\"customMeta\" data-dictid=\"6ef2a80e2116927771915098fa1789\">lag</span> screw and an anti-rotation screw.</li>\n<li>Indications include peritrochanteric, intertrochanteric, and <span class=\"customMeta\" data-dictid=\"6aad7ac3ba16927771992f27501295\">subtrochanteric</span> fractures.</li>\n<li>It is contraindicated for <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> neck fractures.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Bullenwächter\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Proximal_femur_nail.jpg\" data-tags=\"\" height=\"182\" src=\"https://image.prepladder.com/content/b0nm3x6inNWXVBuy6JMk1745558784.png\" width=\"50\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Hellerhoff\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Femurfraktur_unter_Bisphosphonattherapie_57W_-_CT_Topo_Volumen_Rendering_postoperatives_Roentgen_-_001.jpg\" data-tags=\"\" height=\"178\" src=\"https://image.prepladder.com/content/pOqH3BugIulXiGSvbA1g1745558784.png\" width=\"279\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Kuntscher Nail</strong></p>\n<ul>\n<li>Used for internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> of <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> fractures.</li>\n<li>The nail is a <span class=\"customMeta\" data-dictid=\"3f9a320e1a169277718983ee3d1860\">hollow</span> tube with a cloverleaf shape for rotational stability.</li>\n<li>Fixation is based on three-point fixation: at both ends and the isthmus.</li>\n<li>Each end has an \"eye\" for the <span class=\"customMeta\" data-dictid=\"42e78986ec16927771874f3766e591\">extractor</span> hook during removal.</li>\n<li>Nail size is determined by measuring from the <span class=\"customMeta\" data-dictid=\"ff2029fa511692777188fef4dab16c\">greater trochanter</span> to the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"9d86b5d3351692777190224c62427b\">knee joint</span> line and subtracting 2 cm.</li>\n<li>About 2 cm of the nail is left protruding at the <span class=\"customMeta\" data-dictid=\"c4bb41d0e016927772003539a49a35\">trochanter</span> for removal, usually 2 years post-operation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Seven young\" data-hash=\"\" data-license=\"CC BY-NC 3.0\" data-source=\"https://www.researchgate.net/figure/Kuentschers-first-design-of-intramedullary-nail-had-a-V-shaped-cross-section-nail-on-the_fig4_264165838\" data-tags=\"\" height=\"142\" src=\"https://image.prepladder.com/content/JKabmY8retyYE6Eq8Lj51745558784.png\" width=\"276\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Bharti A, Kumar S, Kushwaha S, et al.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.cureus.com/articles/38799-kuntscher-nail-a-forgotten-entity-yet-a-reliable-modality-in-treatment-of-winquist-type-i-and-ii-closed-femoral-shaft-fractures#!/authors\" data-tags=\"\" height=\"218\" src=\"https://image.prepladder.com/content/Wgpp9jkjekkeiaxuZIvM1745558784.png\" width=\"330\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Kirschner wire (K wire)</strong></p>\n<ul>\n<li>Thin, straight steel wire with a <span class=\"customMeta\" data-dictid=\"afb15e4a331692777186e495b370a1\">diameter</span> of 1 to 3 mm.</li>\n<li>Uses include:\n\t\t\t\t<ul>\n<li>Internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> of small bones.</li>\n<li>Tension band <span class=\"customMeta\" data-dictid=\"6ef263e89e169277720230becfc5ec\">wiring</span> in patella</li>\n<li>Applying <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> (e.g., through the olecranon).</li>\n<li>Fixing fractures in children.</li>\n<li>Used in Ilizarov’s <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> system.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Kischner- wire\" data-author=\"Netha Hussain\" data-hash=\"12470\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:K_wire.jpg\" data-tags=\"May2025\" height=\"100\" src=\"https://image.prepladder.com/notes/asyn1Q2qWQ9YnFVpKS181747033447.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Hellerhoff\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Zuggurtungs-Osteosynthese_bei_Patella-Querfraktur.png\" data-tags=\"\" height=\"206\" src=\"https://image.prepladder.com/content/2DUEBISPwcnm96iT0vak1745558784.png\" width=\"288\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Steinmann Pin</strong></p>\n<ul>\n<li>Stout, straight steel rod with a <span class=\"customMeta\" data-dictid=\"afb15e4a331692777186e495b370a1\">diameter</span> of 3 to 6 mm.</li>\n<li>Primarily used for skeletal traction.</li>\n<li>Common sites for <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> include the upper end of the tibia, the <span class=\"customMeta\" data-dictid=\"043a86fa0016927771998a67e65e6a\">supracondylar</span> region of the femur, and the calcaneum.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Netha Hussain\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Steinman_pins.jpg\" data-tags=\"\" height=\"154\" src=\"https://image.prepladder.com/content/ZeR0rLE3GK3iBlCiFBQn1745558784.png\" width=\"204\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"DeFroda, Steven &amp; Gil, Joseph &amp; Born, Christopher. \" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Distal-femoral-traction-pin-landmarks-a-The-patella-is-marked-four-dots-as-well-as_fig2_305633840\" data-tags=\"\" height=\"264\" src=\"https://image.prepladder.com/content/ahfbuDT7FJz4x0LACgRk1745558784.png\" width=\"221\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bohler’s <span class=\"customMeta\" data-dictid=\"ed07d4ffa61692777199a9a50d1971\">Stirrup</span> </strong></p>\n<ul>\n<li>A device used for holding a Steinmann pin and applying traction.</li>\n<li>Side screws secure the pin in place.</li>\n<li>Allows for changing the direction of <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> without moving the pin inside the bone.</li>\n<li>Helps avoid <span class=\"customMeta\" data-dictid=\"15228e561416927771918a5e9e15db\">loosening</span> of the pin during <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> adjustments.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Netha Hussain\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Bohler%27s_stirrup.jpg\" data-tags=\"\" height=\"166\" src=\"https://image.prepladder.com/content/yuZ7IMeb4MNFLISiCxOy1745558784.png\" width=\"285\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thomas Splint:</strong></p>\n<ul>\n<li>Primarily for the <span class=\"customMeta\" data-dictid=\"6694ddb1db1692777199c9a1e38bf0\">stabilization</span> and <span class=\"customMeta\" data-dictid=\"3024d9916e16927771896f5b7159b6\">immobilization</span> of fractures in the <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> or tibia.</li>\n<li>It consists of a metal frame that supports the limb, preventing movement and reducing the risk of further injury.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Thomas splint\" data-author=\"\" data-hash=\"12467\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" height=\"270\" src=\"https://image.prepladder.com/notes/xEGWjTpANAsTWHLwmdGN1747033134.png\" width=\"270\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Steinmann Pin:</strong></p>\n<ul>\n<li>It is a large, stainless steel pin used for internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> of fractures or to stabilize bones during surgery.</li>\n<li>Typically inserted percutaneously (through the skin) or during surgery and is used to hold bones in place for proper healing.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Netha Hussain\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Steinman_pins.jpg\" data-tags=\"\" height=\"183\" src=\"https://image.prepladder.com/content/ozcm1PP3TiJjfOG5uVj41745558784.png\" width=\"243\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Denham's Pin:</strong></p>\n<ul>\n<li>It is used for joint stabilization, often in the hip joint.</li>\n<li>It is inserted into the bone and can be used for <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> or temporary <span class=\"customMeta\" data-dictid=\"6694ddb1db1692777199c9a1e38bf0\">stabilization</span> while healing.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Denham's Pin\" data-author=\"Netha Hussain\" data-hash=\"12468\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Denham_pin.jpg\" data-tags=\"May2025\" height=\"180\" src=\"https://image.prepladder.com/notes/0Oy0ULcaDRbGdcFYonve1747033236.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bohler-Braun Splint:</strong></p>\n<ul>\n<li>Splint used for the <span class=\"customMeta\" data-dictid=\"3024d9916e16927771896f5b7159b6\">immobilization</span> of fractures, especially in the thigh and leg.</li>\n<li>It is a two-piece <span class=\"customMeta\" data-dictid=\"7f606f911b1692777199eb69ab67c5\">splint</span> made of metal and is commonly used for fractures of the <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> and tibia.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Bohler Braun Splint\" data-author=\"AfroBrazilian\" data-hash=\"12469\" data-license=\"CC0 1.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Bohler%27s_splint_with_extension_01.jpg\" data-tags=\"May2025\" height=\"271\" src=\"https://image.prepladder.com/notes/NBuk0nhS7B2vUBCdLVXD1747033301.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n<p><strong>References:</strong></p>\n<ul><li>↳ Orthopaedic Instruments - Surgical Holdings</li><li>↳ Proximal femoral nail fixation | Radiology Reference Article | Radiopaedia.org</li></u\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Following a road traffic accident, a patient develops type IIIa compound tibial fracture. Arrange the following external fixators in decreasing order of their stability (highest to lowest) 1. Ilizarov fixator 2. Uniplanar with a single rod 3. Uniplanar with double rod 4. Biplanar frame/Ring with a cylindrical rod", "options": [{"label": "A", "text": "1 &amp;gt; 2 &amp;gt; 3 &amp;gt; 4", "correct": false}, {"label": "B", "text": "2 &amp;gt; 4 &amp;gt; 3 &amp;gt; 1", "correct": false}, {"label": "C", "text": "1 &amp;gt; 4 &amp;gt; 3 &amp;gt; 2", "correct": true}, {"label": "D", "text": "2 &amp;gt; 3 &amp;gt; 1 &amp;gt; 4", "correct": false}], "correct_answer": "C. 1 &gt; 4 &gt; 3 &gt; 2", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/TfMf8bAEQ0owFOHZGskP1745558906.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 15-year-old boy was brought to the ER following a motor vehicle collision complaining of pain over the hip. The x-ray is given below. What will be the next step of management?", "options": [{"label": "A", "text": "Closed reduction and assessment of hip stability", "correct": true}, {"label": "B", "text": "CT pelvis with 3D reconstruction", "correct": false}, {"label": "C", "text": "High weight skeletal traction", "correct": false}, {"label": "D", "text": "Open reduction and reconstruction of posterior pillar of acetabulum", "correct": false}], "correct_answer": "A. Closed reduction and assessment of hip stability", "question_images": ["https://image.prepladder.com/notes/co67gqhVD76t7Zvqbpku1747033842.png"], "explanation_images": ["https://image.prepladder.com/notes/oSEqwrtsCuM2dZKyiJl31747034025.png", "https://image.prepladder.com/content/O1kUKzI6V6CnXUQQ3z981745559224.png", "https://image.prepladder.com/notes/IvRqeEHzlV91C1sBK4fm1747034047.png", "https://image.prepladder.com/content/CdhgV0Myz9GBedtbrg5W1745559232.png"], "explanation": "<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:362px\">\n<p style=\"text-align:center\"><strong>Posterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:327px\">\n<p style=\"text-align:center\"><strong>Anterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:70px; vertical-align:top; width:362px\">\n<p><strong>Mechanism of injury:</strong><br/>\n\t\t\tCaused by force along the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> with the hip flexed (e.g., <strong>dashboard injury </strong>in motor accidents).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; height:70px; vertical-align:top; width:327px\">\n<p><strong>Mechanism of injury:</strong></p>\n<p>Rare injury that occurs with forced <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> and external rotation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:285px; vertical-align:top; width:362px\">\n<p><strong>Clinical Features:</strong></p>\n<ul>\n<li>History of trauma.</li>\n<li>Pain, swelling.</li>\n<li>Deformity: <strong>flexion</strong>, <strong>adduction</strong>, <strong>internal rotation</strong>.</li>\n<li><strong>Shortening </strong>of the leg.</li>\n<li><strong>Femoral head is </strong>palpable in the <strong>gluteal </strong>region.</li>\n</ul>\n<p><strong>Radiological Features:</strong></p>\n<ul>\n<li>Femoral head displaced from the acetabulum.</li>\n<li>The thigh is internally rotated, the <span class=\"customMeta\" data-dictid=\"0404f7b31816927771912f2b470952\">lesser trochanter</span> is not seen, and Shenton’s line is broken.</li>\n<li>May require a CT scan for associated fractures.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; height:285px; vertical-align:top; width:327px\">\n<p><strong>Clinical features: </strong></p>\n<ul>\n<li>The limb appears <strong>externally rotated.</strong></li>\n<li>Possible <strong>lengthening of the affected limb </strong></li>\n<li><strong>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head </strong>is <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> in the <strong>groin</strong>.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:285px; vertical-align:top; width:362px\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Posterior dislocation of the hip\" data-author=\"P Sanjay, N Prasad, S Raman, A Kamal\" data-hash=\"12472\" data-license=\"NA\" data-source=\"https://ispub.com/IJEM/1/2/4360\" data-tags=\"May2025\" height=\"289\" src=\"https://image.prepladder.com/notes/oSEqwrtsCuM2dZKyiJl31747034025.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Hip_dislocation#/media/File:HipdisX.png\" data-tags=\"\" height=\"435\" src=\"https://image.prepladder.com/content/O1kUKzI6V6CnXUQQ3z981745559224.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; height:285px; text-align:center; vertical-align:top; width:327px\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Anterior dislocation of hip\" data-author=\"Mayur Nayak, Rahul Yadav, Binay K. Sahu, Venkatesan S. Kumar, Vijay Sharma\" data-hash=\"12474\" data-license=\"CC BY\" data-source=\"https://www.cureus.com/articles/18111-an-unusual-presentation-of-pubic-type-anterior-hip-dislocation-with-concomitant-anterior-and-posterior-acetabular-wall-fracture#!/\" data-tags=\"May2025\" height=\"100\" src=\"https://image.prepladder.com/notes/IvRqeEHzlV91C1sBK4fm1747034047.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n\t\t\t \n\n\t\t\t<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Lorenzo Ceri, Luigi Zanna, Roberto Buzzi, Pietro De Biase\" data-hash=\"\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.sciencedirect.com/science/article/pii/S235264402100056X?via%3Dihub\" data-tags=\"\" height=\"294\" src=\"https://image.prepladder.com/content/CdhgV0Myz9GBedtbrg5W1745559232.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a patient who is brought to the hospital after a road traffic accident, complaining of pain around the left hip joint, and is found to have a flexed, adducted, and internally rotated affected limb with noticeable shortening?", "options": [{"label": "A", "text": "Anterior hip dislocation", "correct": false}, {"label": "B", "text": "Posterior hip dislocation", "correct": true}, {"label": "C", "text": "Central fracture dislocation of hip", "correct": false}, {"label": "D", "text": "Intertrochanteric fracture", "correct": false}], "correct_answer": "B. Posterior hip dislocation", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/193kUOlziSZFGOih3sZ81745393575.png", "https://image.prepladder.com/notes/FJ4eQV2ezpZkhr9p769C1746429431.png", "https://image.prepladder.com/notes/yG0XhhUfUiGBtlgXURRF1746429608.png", "https://image.prepladder.com/notes/2r8NQycTvGROX6xqAMo61746429632.png", "https://image.prepladder.com/notes/rT2uaJzChN8SkicIU7aK1746429672.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Posterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Anterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Central <span class=\"customMeta\" data-dictid=\"1954a47dd6169277720351aed9c4c0\">fracture-dislocation</span> of hip </strong><strong>(Option C) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of injury:</strong></p>\n<ul>\n<li>Caused by force along the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> with the hip flexed (e.g., <strong>dashboard injury </strong>in motor accidents).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of injury:</strong></p>\n<ul>\n<li>Rare injury that occurs with forced <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> and external rotation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of injury: </strong></p>\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head is driven through the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> wall of the <span class=\"customMeta\" data-dictid=\"58112da05c1692777180028ce828fa\">acetabulum</span> into the <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> cavity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features:</strong></p>\n<ul>\n<li>History of trauma.</li>\n<li>Pain, swelling.</li>\n<li>Deformity: <strong>flexion</strong>, <strong>adduction</strong>, <strong>internal rotation</strong>.</li>\n<li><strong>Shortening </strong>of the leg.</li>\n<li><strong>Femoral head is </strong>palpable in the <strong>gluteal </strong>region.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features: </strong></p>\n<ul>\n<li>The limb appears <strong>externally rotated.</strong></li>\n<li>Possible <strong>lengthening </strong><strong>of the affected limb </strong></li>\n<li><strong>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head </strong>is <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> in the <strong>groin</strong>.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features:</strong></p>\n<ul>\n<li>Varying <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> is seen.</li>\n<li>Joint <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> and <span class=\"customMeta\" data-dictid=\"720567fecd169277719411dda3d1a2\">osteoarthritis</span> are very likely.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"P Sanjay, N Prasad, S Raman, A Kamal\" data-hash=\"\" data-license=\"NA\" data-source=\"https://ispub.com/IJEM/1/2/4360\" data-tags=\"\" height=\"196\" src=\"https://image.prepladder.com/content/193kUOlziSZFGOih3sZ81745393575.png\" width=\"203\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Anterior hip dislocation \" data-author=\"Mayur Nayak, Rahul Yadav, Binay K. Sahu, Venkatesan S. Kumar, Vijay Sharma\" data-hash=\"11734\" data-license=\"CC BY\" data-source=\"https://www.cureus.com/articles/18111-an-unusual-presentation-of-pubic-type-anterior-hip-dislocation-with-concomitant-anterior-and-posterior-acetabular-wall-fracture#!/\" data-tags=\"May2025\" height=\"100\" src=\"https://image.prepladder.com/notes/FJ4eQV2ezpZkhr9p769C1746429431.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Posterior dislocation of the hip\" data-author=\"James Heilman, MD\" data-hash=\"11735\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Hip_dislocation#/media/File:HipdisX.png\" data-tags=\"May2025\" height=\"270\" src=\"https://image.prepladder.com/notes/yG0XhhUfUiGBtlgXURRF1746429608.png\" width=\"184\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Anterior hip dislocation \" data-author=\"Lorenzo Ceri, Luigi Zanna, Roberto Buzzi, Pietro De Biase\" data-hash=\"11736\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.sciencedirect.com/science/article/pii/S235264402100056X?via%3Dihub\" data-tags=\"May2025\" height=\"274\" src=\"https://image.prepladder.com/notes/2r8NQycTvGROX6xqAMo61746429632.png\" width=\"280\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Central fracture-dislocation of the hip\" data-author=\"Samir Benoudina\" data-hash=\"11737\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/central-fracture-dislocation-of-the-acetabulum-2\" data-tags=\"May2025\" height=\"229\" src=\"https://image.prepladder.com/notes/rT2uaJzChN8SkicIU7aK1746429672.png\" width=\"311\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which zone demonstrates the most optimal healing in the repair of a meniscal tear?", "options": [{"label": "A", "text": "Red zone", "correct": true}, {"label": "B", "text": "White zone", "correct": false}, {"label": "C", "text": "Gray zone", "correct": false}, {"label": "D", "text": "Red+White zone", "correct": false}], "correct_answer": "A. Red zone", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the potential diagnosis for a 22-year-old male patient presenting with a history of accident, exhibiting leg abduction and external rotation?", "options": [{"label": "A", "text": "Anterior dislocation of the hip", "correct": true}, {"label": "B", "text": "Posterior dislocation of the hip", "correct": false}, {"label": "C", "text": "Intertrochanteric fracture", "correct": false}, {"label": "D", "text": "Fracture neck of femur", "correct": false}], "correct_answer": "A. Anterior dislocation of the hip", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/TlRijSolklfleSzNZaZ41746522253.png", "https://image.prepladder.com/notes/ry7UfcsEI1GYaqNi8D1h1746522282.png", "https://image.prepladder.com/notes/IrWHcuhejNOI81kbnBbK1746522310.png", "https://image.prepladder.com/notes/JvKcCcV2rDeq9tI5B2J31746522344.png", "https://image.prepladder.com/notes/GGur552CJ5nifHb6xW5x1746522370.png", "https://image.prepladder.com/notes/vU7I5PBoEbq87hkmBMSV1746522399.png", "https://image.prepladder.com/notes/fhCabxgW5jHQw60xYSyr1746522422.png", "https://image.prepladder.com/notes/irWdaRDjc3KifeZr8jVb1746522451.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Anterior hip <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Type I: Pubic (superior) injuries</li>\n<li>Type II: Obturator (inferior) injuries</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reduction should be performed as soon as possible under <span class=\"customMeta\" data-dictid=\"b81cee1b5f16927771987099f651a0\">sedation</span> or general anesthesia.</li>\n<li>Closed reduction technique:\n\t\t\t\t<ul>\n<li>Hold the affected leg in external rotation, abduction, and flexion.</li>\n<li>Apply <span class=\"customMeta\" data-dictid=\"7ba18aa5e616927771918a45051a40\">longitudinal</span> traction.</li>\n<li>Internally and externally <span class=\"customMeta\" data-dictid=\"ed17327223169277719753b0e5d6b4\">rotate</span> the leg until reduction is achieved, and apply <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> pressure on the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head if necessary.</li>\n<li>If repeated attempts fail, consider an open reduction.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Injury to the <strong>sciatic nerve. </strong></li>\n<li><strong>Avascular <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head</strong>: may require hip replacement if <span class=\"customMeta\" data-dictid=\"720567fecd169277719411dda3d1a2\">osteoarthritis</span> develops.</li>\n</ul>\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"AVN of Femur Head\" data-author=\"Mikael Häggström\" data-hash=\"12181\" data-license=\"CC0\" data-source=\"https://commons.wikimedia.org/wiki/File:X-ray_of_idiopathic_avascular_necrosis_of_the_femoral_head_-_Anteroposterior.jpg\" data-tags=\"May2025\" height=\"283\" src=\"https://image.prepladder.com/notes/TlRijSolklfleSzNZaZ41746522253.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li> <strong>Osteoarthritis</strong>: develops years later. Treatment varies from conservative to total hip replacement.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Hip Osteoarthritis\" data-author='\"Tom D. Turmezei Ken E. S. Poole\" ' data-hash=\"12183\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Marginal-osteophytes-in-a-left-hip-with-moderate-osteoarthritis-as-seen-with-a-coronal-T1_fig5_225079588\" data-tags=\"May2025\" height=\"221\" src=\"https://image.prepladder.com/notes/ry7UfcsEI1GYaqNi8D1h1746522282.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<ul>\n<li><strong>Myositis Ossificans</strong><strong>:</strong> Develops weeks to months post-injury and is characterized by pain and stiffness. Ill-advised vigorous and improper <span class=\"customMeta\" data-dictid=\"c515f6a71d16927771919f574f1ee9\">massage</span> following trauma is the most common cause.Treatment includes rest and analgesics.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Myositis Ossificans at Hip\" data-author=\"Dishanth Sivakumaran a, Kalaventhan Pathinathan a, Joy Danisious a, Gobyshanger Thayasivam b\" data-hash=\"12185\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.sciencedirect.com/science/article/pii/S221026122100612X?via%3Dihub\" data-tags=\"May2025\" height=\"212\" src=\"https://image.prepladder.com/notes/IrWHcuhejNOI81kbnBbK1746522310.png\" width=\"479\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<ul>\n<li>Potential for associated <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head fractures.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Posterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Anterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Central <span class=\"customMeta\" data-dictid=\"1954a47dd6169277720351aed9c4c0\">fracture-dislocation</span> of hip </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of injury:</strong></p>\n<ul>\n<li>Caused by force along the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> with the hip flexed (e.g., <strong>dashboard injury </strong>in motor accidents).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of injury:</strong></p>\n<ul>\n<li>Rare injury that occurs with forced <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> and external rotation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of injury: </strong></p>\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head is driven through the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> wall of the <span class=\"customMeta\" data-dictid=\"58112da05c1692777180028ce828fa\">acetabulum</span> into the <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> cavity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features:</strong></p>\n<ul>\n<li>History of trauma.</li>\n<li>Pain, swelling.</li>\n<li>Deformity: <strong>flexion</strong>, <strong>adduction</strong>, <strong>internal rotation</strong>.</li>\n<li><strong>Shortening </strong>of the leg.</li>\n<li><strong>Femoral head is </strong>palpable in the <strong>gluteal </strong>region.</li>\n</ul>\n<p><strong>Radiological Features:</strong></p>\n<ul>\n<li>Femoral head displaced from the acetabulum.</li>\n<li>The thigh is internally rotated, the <span class=\"customMeta\" data-dictid=\"0404f7b31816927771912f2b470952\">lesser trochanter</span> is not seen, and Shenton’s line is broken.</li>\n<li>May require a CT scan for associated fractures.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features: </strong></p>\n<ul>\n<li>The limb appears <strong>externally rotated.</strong></li>\n<li>Possible <strong>lengthening of the affected limb </strong></li>\n<li><strong>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head </strong>is <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> in the <strong>groin</strong>.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features:</strong></p>\n<ul>\n<li>Varying <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> is seen.</li>\n<li>Joint <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> and <span class=\"customMeta\" data-dictid=\"720567fecd169277719411dda3d1a2\">osteoarthritis</span> are very likely.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Posterior dislocation of hip attitude\" data-author=\"\" data-hash=\"12187\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" height=\"300\" src=\"https://image.prepladder.com/notes/JvKcCcV2rDeq9tI5B2J31746522344.png\" width=\"300\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Anterior dislocation of hip attitude\" data-author=\"\" data-hash=\"12189\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" height=\"300\" src=\"https://image.prepladder.com/notes/GGur552CJ5nifHb6xW5x1746522370.png\" width=\"300\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"X-ray - Posterior hip dislocation\" data-author=\"James Heilman, MD\" data-hash=\"12191\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Hip_dislocation#/media/File:HipdisX.png\" data-tags=\"May2025\" height=\"293\" src=\"https://image.prepladder.com/notes/vU7I5PBoEbq87hkmBMSV1746522399.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Anterior dislocation of hip\" data-author=\"Lorenzo Ceri, Luigi Zanna, Roberto Buzzi, Pietro De Biase\" data-hash=\"12193\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.sciencedirect.com/science/article/pii/S235264402100056X?via%3Dihub \" data-tags=\"May2025\" height=\"294\" src=\"https://image.prepladder.com/notes/fhCabxgW5jHQw60xYSyr1746522422.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Central fracture-dislocation of the hip\" data-author=\"Samir Benoudina\" data-hash=\"12195\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/central-fracture-dislocation-of-the-acetabulum-2\" data-tags=\"May2025\" height=\"221\" src=\"https://image.prepladder.com/notes/irWdaRDjc3KifeZr8jVb1746522451.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a patient who was admitted to the intensive care unit 48 hours after fracturing their femur, with a saturation of oxygen in the rebreathing unit at 100%, but their SpO 2 remained at 60%? The patient is also experiencing confusion, and a chest radiograph shows clear lung fields.", "options": [{"label": "A", "text": "Pulmonary embolism", "correct": false}, {"label": "B", "text": "Fat embolism", "correct": true}, {"label": "C", "text": "ARDS", "correct": false}, {"label": "D", "text": "Occult pneumothorax", "correct": false}], "correct_answer": "B. Fat embolism", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/991mnf9T9KC84AWH1AaP1745217891.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fat Embolism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fat <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> is a multi-organ disorder caused by fat globules entering the bloodstream, commonly occurring after high-risk <span class=\"customMeta\" data-dictid=\"0b8eb98a3f16927771945b310aec42\">orthopedic</span> injuries, <strong>particularly <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> fractures.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classic Triad</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hypoxia</li>\n<li>Petechiae</li>\n<li>Altered mental status</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tachycardia, fever, anemia, thrombocytopenia, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> (e.g., tachypnea, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> acidosis).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Young adults</strong> (20-30 years): <strong>Long bone fractures</strong></li>\n<li><strong>Iatrogenic cause: </strong>Occurs after <span class=\"customMeta\" data-dictid=\"5b22285eec169277719026820db11c\">intramedullary</span> (IM) <span class=\"customMeta\" data-dictid=\"cb2d373f701692777193324602b6fa\">nailing</span> of the femur.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Following injury, fat from <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> or <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> <span class=\"customMeta\" data-dictid=\"36e1a07ab01692777180db73f01e84\">agglutination</span> enters injured vessels and travels as emboli, leading to various clinical manifestations.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Chest X-ray: </strong>Commonly clear lung fields, occasionally <strong>Snowstorm appearance is seen (pathognomonic)</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Arencibia, Yanetsy &amp; Vo, Mai &amp; Kinaga, Jennifer &amp; Uribe, Jorge &amp; Velasquez, Gloria &amp; Madruga, Mario &amp; Carlan, Steve.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/CXR-showed-diffuse-bilateral-infiltrates-in-a-snowstorm-pattern_fig3_329820422\" data-tags=\"\" height=\"345\" src=\"https://image.prepladder.com/content/991mnf9T9KC84AWH1AaP1745217891.png\" width=\"388\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>PaO₂ &lt;60 mm Hg</strong></li>\n<li>Platelet count &lt;1.5 lakhs</li>\n<li><strong>ECG: </strong>Prominent S-wave</li>\n<li><strong>Other lab findings: </strong>Anemia, hypocalcemia</li>\n<li><strong>CT scan and MRI: </strong>Assess severity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Respiratory support: </strong>Oxygen or <span class=\"customMeta\" data-dictid=\"072a58ab7d169277720130e58f9614\">ventilator</span> support to restore PaO₂</li>\n<li><strong>Drug therapy:</strong>\n<ul>\n<li><strong>Steroids: </strong>Reduce lung <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and improve gas exchange.</li>\n<li><strong>Heparin: </strong>Lipolytic and <span class=\"customMeta\" data-dictid=\"257da9409416927771815e64ee5df1\">antiplatelet</span> agent.</li>\n<li><strong>Low <span class=\"customMeta\" data-dictid=\"b2df2436bf1692777193d90e9c0132\">molecular weight</span> dextran: </strong>Increases <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> volume.</li>\n<li>Antibiotics and other supportive care.</li>\n</ul>\n</li>\n<li><strong>Definitive <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> treatment: </strong>Early <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> to prevent worsening.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the case of an ongoing bleeding in a patient with a fracture of the pelvic bone, what is the immediate action that needs to be taken to address the situation, if the patient is in hypotension?", "options": [{"label": "A", "text": "Crystalloids", "correct": true}, {"label": "B", "text": "External fixation", "correct": false}, {"label": "C", "text": "Internal definite fixation", "correct": false}, {"label": "D", "text": "Use Pelvic Binders", "correct": false}], "correct_answer": "A. Crystalloids", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/HnhrGbm2WyY04wsIkKx11744953290.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old patient presents with complaints of back pain, stiffness, and recurrent episodes of eye pain with redness. On examination, they are found to have anterior uveitis and sacroiliitis. Which of the following HLA is commonly involved", "options": [{"label": "A", "text": "HLA DQB1", "correct": false}, {"label": "B", "text": "HLA DR3", "correct": false}, {"label": "C", "text": "HLA B27", "correct": true}, {"label": "D", "text": "HLA DR4", "correct": false}], "correct_answer": "C. HLA B27", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/biwXMsEPgkqKXzuJwxRt1741181219.png", "https://image.prepladder.com/content/mA6UlZ3hGfXsPuV322BF1741181246.png", "https://image.prepladder.com/content/93V02Ocz9NXGYyinerrG1741181264.png", "https://image.prepladder.com/content/NZpoDUWwglFvmV5yZNpv1741181288.png", "https://image.prepladder.com/content/EznPFD6ZdthQ6CuQKzWO1741181302.png", "https://image.prepladder.com/content/0soRMwUp5oc5PM5m5v621741181323.png", "https://image.prepladder.com/content/xyrbJpqgnfWu5BZV1Ll31741181337.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:691px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> disease primarily affecting the <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> <span class=\"customMeta\" data-dictid=\"70f596ae8f16927771983211d9e56f\">skeleton</span> (spine and <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joints), leading to pain, stiffness, and <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> fusion<strong> (bamboo spine)</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unknown; genetic<strong> (HLA-B27</strong>) and environmental factors involved. HLA-B27 is positive in 90% of cases, but not all carriers develop AS.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inflammation at entheses → <span class=\"customMeta\" data-dictid=\"d6ccfc448916927771877d9bde179f\">Erosive</span> changes → New bone formation → Syndesmophytes → <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">Spinal</span> <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> (ankylosis).</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/biwXMsEPgkqKXzuJwxRt1741181219.png\" width=\"1999\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Musculoskeletal Symptoms:</strong></p>\n<ul>\n<li>Chronic low back pain (worse after inactivity, better with activity)</li>\n<li>Limited <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> mobility</li>\n<li>Enthesitis (Achilles, <span class=\"customMeta\" data-dictid=\"a7a430f3a9169277719510c13f434d\">plantar</span> fascia)</li>\n<li>Peripheral <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> (hips, shoulders, knees)</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Extra-articular Symptoms:</strong></p>\n<ul>\n<li><strong>Ocular:</strong> <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> <span class=\"customMeta\" data-dictid=\"b07d6fd6ef1692777201015472cd79\">uveitis</span> (pain, redness, photophobia)</li>\n<li><strong>Cardiovascular:</strong> Aortic regurgitation, <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> issues</li>\n<li><strong>Pulmonary: </strong>Apical fibrosis</li>\n<li><strong>Gastrointestinal:</strong> Associated with IBD</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Based on clinical features, <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> studies, and HLA-B27 gene presence. <strong>Modified New York Criteria:</strong></p>\n\t\t\t \n\n\t\t\t<p><strong>Clinical Criteria:</strong></p>\n<ul>\n<li>Low back pain &gt; 3 months (improves with exercise, not with rest)</li>\n<li>Limited <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> spine motion (sagittal/frontal planes)</li>\n<li>Reduced chest expansion (relative to age/sex)</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Radiographic Criteria (X-ray):</strong></p>\n<p>Bilateral <span class=\"customMeta\" data-dictid=\"d17a3a17bc16927771988d9f2533a8\">sacroiliitis</span> (grade 2-4) or <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> <span class=\"customMeta\" data-dictid=\"d17a3a17bc16927771988d9f2533a8\">sacroiliitis</span> (grade 3-4)</p>\n\t\t\t \n\n\t\t\t<p><strong>Radiological Features:</strong></p>\n<ul>\n<li><strong>Blurring/haziness of <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joint</strong></li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1126\" src=\"https://image.prepladder.com/content/mA6UlZ3hGfXsPuV322BF1741181246.png\" width=\"1999\"/></p>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Juxta-articular sclerosis</strong></li>\n<li><strong>Vertical/bridging syndesmophytes</strong></li>\n<li><strong>Squaring of vertebrae</strong></li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/93V02Ocz9NXGYyinerrG1741181264.png\" width=\"1102\"/></p>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Bamboo spine</strong></li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1605\" src=\"https://image.prepladder.com/content/NZpoDUWwglFvmV5yZNpv1741181288.png\" width=\"795\"/></p>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Trolley track sign</strong></li>\n<li><strong>Dagger sign</strong></li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/EznPFD6ZdthQ6CuQKzWO1741181302.png\" width=\"1476\"/></p>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Shiny corner sign/Romanus <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> </strong>(inflammatory lesions at edges of vertebrae)</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1605\" src=\"https://image.prepladder.com/content/0soRMwUp5oc5PM5m5v621741181323.png\" width=\"859\"/></p>\n\t\t\t \n\n\t\t\t<p><strong>MRI:</strong> Early <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> of inflammation</p>\n\t\t\t \n\n\t\t\t<p><strong>Clinical Tests:</strong></p>\n<p><strong>For Sacroiliitis:</strong></p>\n<ul>\n<li>Gaenslen’s test</li>\n<li>Patrick/FABER test</li>\n<li>Figure of 4 test</li>\n<li>Pump handle test</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>For <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">Lumbar</span> Spine:</strong></p>\n<p><strong>Schober/ Modified Schober test</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1000\" src=\"https://image.prepladder.com/content/xyrbJpqgnfWu5BZV1Ll31741181337.png\" width=\"1000\"/></p>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laboratory Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>HLA-B27 positive (90% of cases)</li>\n<li>ESR, CRP: Elevated during active disease, but can be normal</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mechanical low back pain</li>\n<li>Other spondyloarthropathies (e.g., psoriatic arthritis)</li>\n<li>Degenerative disc disease</li>\n<li>Fibromyalgia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Pharmacological:</strong></p>\n<ul>\n<li>Physical therapy (mobility/posture exercises)</li>\n<li>Patient education on disease and exercise importance</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Pharmacological:</strong></p>\n<ul>\n<li>NSAIDs (first-line for pain, stiffness)</li>\n<li>TNF inhibitors (for NSAID-resistant cases)</li>\n<li>IL-17 inhibitors (Secukinumab)</li>\n<li>Sulfasalazine (for <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> arthritis)</li>\n<li>Corticosteroids (short-term <span class=\"customMeta\" data-dictid=\"68e7440bd91692777202d8a14c33e0\">flare</span> control)</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Surgical:</strong></p>\n<ul>\n<li>Hip replacement (for severe hip involvement)</li>\n<li>Spinal surgery (for severe deformities/fractures)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Spinal fractures (minimal trauma)</li>\n<li>Cardiac issues (aortic regurgitation, <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> defects)</li>\n<li>Osteoporosis leading to <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> risk</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Conditions mimicking <span class=\"customMeta\" data-dictid=\"aabbc63449169277718277060e8642\">Ankylosing Spondylitis</span> with <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> fusion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diffuse <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">Idiopathic</span> Skeletal <span class=\"customMeta\" data-dictid=\"8c947f8b081692777189e13a744a05\">Hyperostosis</span> (DISH) (Forestier’s disease)</li>\n<li>Ossification of <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> <span class=\"customMeta\" data-dictid=\"7ba18aa5e616927771918a45051a40\">Longitudinal</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">Ligament</span> (OPLL)</li>\n<li>Spondylosis (Degenerative Disc Disease)</li>\n<li>Psoriatic Arthritis</li>\n<li>Enteropathic <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">Arthritis</span> (IBD-associated)</li>\n<li>Reactive Arthritis</li>\n<li>Rheumatoid <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">Arthritis</span> (RA)</li>\n<li>Juvenile <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">Idiopathic</span> <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">Arthritis</span> (JIA)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old met with a bike accident and presented with the following finding. What is the diagnosis?", "options": [{"label": "A", "text": "Anterior hip dislocation", "correct": true}, {"label": "B", "text": "Posterior hip dislocation", "correct": false}, {"label": "C", "text": "Superior hip dislocation", "correct": false}, {"label": "D", "text": "Both a and b", "correct": false}], "correct_answer": "A. Anterior hip dislocation", "question_images": ["https://image.prepladder.com/content/33ECoaZhkud2FQ6XdDK91741087423.png"], "explanation_images": ["https://image.prepladder.com/content/NPQCcxl5hsgf8CLUAAOZ1741087485.png", "https://image.prepladder.com/content/33ECoaZhkud2FQ6XdDK91741087423.png", "https://image.prepladder.com/content/PAfjIQCWLjvM8sCHv51z1741059939.png", "https://image.prepladder.com/content/YdT8KH1yLO0TmyRgGSH71741059974.png", "https://image.prepladder.com/content/JXtWOXe0wpraZRzwbvFD1741060016.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:722px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Central <span class=\"customMeta\" data-dictid=\"1954a47dd6169277720351aed9c4c0\">fracture-dislocation</span> of hip </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Mechanism of injury:</strong><br/>\n\t\t\t </p>\n<p>Caused by force along the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> with the hip flexed (e.g., <strong>dashboard injury </strong>in motor accidents).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of injury:</strong></p>\n<p>Rare injury that occurs with forced <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> and external rotation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of injury: </strong></p>\n<p>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head is driven through the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> wall of the <span class=\"customMeta\" data-dictid=\"58112da05c1692777180028ce828fa\">acetabulum</span> into the <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> cavity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features:</strong></p>\n<ul>\n<li>History of trauma.</li>\n<li>Pain, swelling.</li>\n<li>Deformity: <strong>flexion</strong>, <strong>adduction</strong>, <strong>internal rotation</strong>.</li>\n<li><strong>Shortening </strong>of the leg.</li>\n<li><strong>Femoral head is </strong>palpable in the <strong>gluteal </strong>region.</li>\n</ul>\n<p><strong>Radiological Features:</strong></p>\n<ul>\n<li>Femoral head displaced from the acetabulum.</li>\n<li>The thigh is internally rotated, the <span class=\"customMeta\" data-dictid=\"0404f7b31816927771912f2b470952\">lesser trochanter</span> is not seen, and Shenton’s line is broken.</li>\n<li>May require a <span class=\"customMeta\" data-dictid=\"871577be5e169277718596f7614659\">CT scan</span> for associated fractures.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features: </strong></p>\n<ul>\n<li>The limb appears <strong>externally rotated.</strong></li>\n<li>Possible <strong>lengthening </strong><strong>of the affected limb </strong></li>\n<li><strong>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head </strong>is <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> in the <strong>groin</strong>.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features:</strong></p>\n<ul>\n<li>Varying <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> is seen.</li>\n<li>Joint <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> and <span class=\"customMeta\" data-dictid=\"720567fecd169277719411dda3d1a2\">osteoarthritis</span> are very likely.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"705\" src=\"https://image.prepladder.com/content/NPQCcxl5hsgf8CLUAAOZ1741087485.png\" width=\"732\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n<p style=\";\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"627\" src=\"https://image.prepladder.com/content/33ECoaZhkud2FQ6XdDK91741087423.png\" width=\"1889\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"402\" src=\"https://image.prepladder.com/content/PAfjIQCWLjvM8sCHv51z1741059939.png\" width=\"276\"/>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"386\" src=\"https://image.prepladder.com/content/YdT8KH1yLO0TmyRgGSH71741059974.png\" width=\"237\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"378\" src=\"https://image.prepladder.com/content/JXtWOXe0wpraZRzwbvFD1741060016.png\" width=\"302\"/>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the orthopedic implant shown in the image", "options": [{"label": "A", "text": "Dynamic hip screw", "correct": true}, {"label": "B", "text": "Adynamic hip screw", "correct": false}, {"label": "C", "text": "Condylar hip screw", "correct": false}, {"label": "D", "text": "Intramedullary nail", "correct": false}], "correct_answer": "A. Dynamic hip screw", "question_images": ["https://image.prepladder.com/content/f2eg90q8b3EjHHk4qxLP1724756230.png"], "explanation_images": ["https://image.prepladder.com/content/CXzEtbPdFoQ2iCqrXXW71748207656.png", "https://image.prepladder.com/content/PfZadOgL6SNLGHOtv7tw1748207687.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with 5th metatarsal fracture. For how many days he/she would have to wear cast?", "options": [{"label": "A", "text": "2-3 weeks", "correct": false}, {"label": "B", "text": "3-5 weeks", "correct": false}, {"label": "C", "text": "6-8 weeks", "correct": true}, {"label": "D", "text": "16- 20 weeks", "correct": false}], "correct_answer": "C. 6-8 weeks", "question_images": ["https://image.prepladder.com/content/5Wk9Mka7g8VK08SqVuse1724837644.png"], "explanation_images": [], "explanation": "<p>Correct Option C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A heavy lifter presents with lower back ache. Identify the nerve compressed in the following disc prolapse?", "options": [{"label": "A", "text": "L4", "correct": false}, {"label": "B", "text": "L5", "correct": true}, {"label": "C", "text": "S1", "correct": false}, {"label": "D", "text": "S4", "correct": false}], "correct_answer": "B. L5", "question_images": ["https://image.prepladder.com/content/7lZvqLbZCjFrq0K3BROD1724837896.png"], "explanation_images": [], "explanation": "<p>Correct Option B - L5\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A man presents with back pain following road traffic accident. There was no history of neurological deficit. X ray spine is done. What is the diagnosis?", "options": [{"label": "A", "text": "Spinous process fracture", "correct": true}, {"label": "B", "text": "Chance fracture", "correct": false}, {"label": "C", "text": "Fracture o base of vertebrae", "correct": false}, {"label": "D", "text": "Compressed fracture", "correct": false}], "correct_answer": "A. Spinous process fracture", "question_images": ["https://image.prepladder.com/content/AtttNjIFxbsJq56NhP141724757430.png"], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"6ecc9fc8e416927771993c575ccc1e\"&gt;Spinous&lt;/span&gt; Process Fractu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which area is affected by the fracture shown in the given X-ray?", "options": [{"label": "A", "text": "Tibial tuberosity fracture", "correct": true}, {"label": "B", "text": "Medial epicondyle of tibia", "correct": false}, {"label": "C", "text": "Gerdy's tubercle fracture", "correct": false}, {"label": "D", "text": "Osgood-Schlatter disease", "correct": false}], "correct_answer": "A. Tibial tuberosity fracture", "question_images": ["https://image.prepladder.com/content/nP07tuDaMr0mhQB0xK201724759039.png"], "explanation_images": [], "explanation": "<table>\n<thead>\n<tr>\n<th>Feature</th>\n<th>Description</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Location</td>\n<td>Anterior <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> (tibial tuberosity)</td>\n</tr>\n<tr>\n<td>Mechanism</td>\n<td>Forceful <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> of <span class=\"customMeta\" data-dictid=\"175fd4b3061692777196c7f28a4c53\">quadriceps</span> (e.g., jumping, kicking)</td>\n</tr>\n<tr>\n<td>Radiograph finding</td>\n<td>Fracture through or below the <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> tuberosity</td>\n</tr>\n<tr>\n<td>Associated conditions</td>\n<td>May be associated with <strong>Osgood-Schlatter disease</strong> as a <span class=\"customMeta\" data-dictid=\"80c0cb2a5f1692777196ba45847553\">predisposing</span> factor</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old female presented with back pain for six months. Her CT scan image is given below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Paget's disease", "correct": false}, {"label": "B", "text": "Osteoporosis", "correct": false}, {"label": "C", "text": "Spondylolisthesis", "correct": true}, {"label": "D", "text": "Renal osteodystrophy", "correct": false}], "correct_answer": "C. Spondylolisthesis", "question_images": ["https://image.prepladder.com/content/lI6s2wRNZjFugN1Gr1g21724908916.png"], "explanation_images": ["https://image.prepladder.com/content/8dNkj3CqqfxY2qJ3iKMV1724838478.png"], "explanation": "<p>Correct Option C – Spondylolisth\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient suffers an inversion injury to the ankle. Which structure is most likely to get injured?", "options": [{"label": "A", "text": "Tibialis anterior tendon", "correct": false}, {"label": "B", "text": "Tibialis posterior tendon", "correct": false}, {"label": "C", "text": "Extensor hallucis longus tendon", "correct": false}, {"label": "D", "text": "Anterior talofibular ligament", "correct": true}], "correct_answer": "D. Anterior talofibular ligament", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\"&gt;Anterior&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"02a8b612541692777200b54f68e5f6\"&gt;talofibular&lt;/span&gt; lig\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the type of fracture in a patient who sustained a road traffic accident resulting in fractures of both the tibia and fibula.", "options": [{"label": "A", "text": "Bumper Fracture", "correct": true}, {"label": "B", "text": "Patella sleeve fracture", "correct": false}, {"label": "C", "text": "Depressed skull fracture", "correct": false}, {"label": "D", "text": "Cervical fracture", "correct": false}], "correct_answer": "A. Bumper Fracture", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/UhlKhA57jzbeHoaEMr9U1747288145.png", "https://image.prepladder.com/content/V21bDEC8xtSBzrrS0Rsg1747288145.png", "https://image.prepladder.com/notes/a70WvqFKWh8QeGw4cdop1747657975.png", "https://image.prepladder.com/notes/v6tLDX6CQDAPSxq0z5WN1747657993.png", "https://image.prepladder.com/notes/v4neOs3es4CRdwz6tjYF1747658010.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> <span class=\"customMeta\" data-dictid=\"7a4ced7da71692777195938424f299\">plateau</span> refers to the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> surface, which comprises the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> surfaces of the respective <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> condyles.</p>\n<p><strong>Lateral <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> <span class=\"customMeta\" data-dictid=\"7a4ced7da71692777195938424f299\">plateau</span> fractures are the most common.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The main mechanism of injury is a <span class=\"customMeta\" data-dictid=\"5cdf29eaf516927772012b4a16cde1\">varus</span> or <span class=\"customMeta\" data-dictid=\"e33d939e82169277720167f59b0ee2\">valgus</span> force, with or without <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> load.</li>\n<li>Young Adults: Road traffic accidents, leading to <strong>split fractures</strong> (high <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> injury risk).</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"239\" src=\"https://image.prepladder.com/content/UhlKhA57jzbeHoaEMr9U1747288145.png\" width=\"239\"/></p>\n<ul>\n<li>Elderly: Trivial falls, causing depression or <strong>split depression fractures</strong> (associated with osteoporosis) (low <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> injury risk).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Classification (Schatzker)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type I:</strong> <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> <span class=\"customMeta\" data-dictid=\"7a4ced7da71692777195938424f299\">plateau</span> split <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> (young adults).</p>\n<p><strong>Type II:</strong> <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> <span class=\"customMeta\" data-dictid=\"7a4ced7da71692777195938424f299\">plateau</span> split depression (young adults).</p>\n<p><strong>Type III:</strong> <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> <span class=\"customMeta\" data-dictid=\"7a4ced7da71692777195938424f299\">plateau</span> pure depression (elderly).</p>\n<p><strong>Type IV: </strong>Medial <span class=\"customMeta\" data-dictid=\"7a4ced7da71692777195938424f299\">plateau</span> fracture.</p>\n<p><strong>Type V: </strong>Bicondylar fracture.</p>\n<p><strong>Type VI: </strong>Dissociation of <span class=\"customMeta\" data-dictid=\"8ccb80bd4d169277719296d80e2193\">metaphysis</span> and diaphysis.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"385\" src=\"https://image.prepladder.com/content/V21bDEC8xtSBzrrS0Rsg1747288145.png\" width=\"384\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Knee <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> due to hemarthrosis.</li>\n<li>Inability to bear weight</li>\n<li>Reduce range of knee movements</li>\n<li>Compartment syndrome (earliest sign: <strong>stretch pain</strong>).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>X-ray:</strong> Initial <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> detection.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"Tibial plateau fracture A\" data-author=\"James Heilman, MD\" data-hash=\"13004\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Tibial_plateau_fracture#/media/File:TibPlatFracPlainMark.png https://en.wikipedia.org/wiki/Crus_fracture#/media/File:TibPlateauF.PNG https://en.wikipedia.org/wiki/Tibial_plateau_fracture#/media/File:TibPlateauBadMark.png\" data-tags=\"May2025\" height=\"177\" src=\"https://image.prepladder.com/notes/a70WvqFKWh8QeGw4cdop1747657975.png\" width=\"168\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p> </p>\n<figure class=\"caption_element\"><img alt=\"Tibial plateau fracture B\" data-author=\"James Heilman, MD\" data-hash=\"13005\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Tibial_plateau_fracture#/media/File:TibPlatFracPlainMark.png https://en.wikipedia.org/wiki/Crus_fracture#/media/File:TibPlateauF.PNG https://en.wikipedia.org/wiki/Tibial_plateau_fracture#/media/File:TibPlateauBadMark.png\" data-tags=\"May2025\" height=\"172\" src=\"https://image.prepladder.com/notes/v6tLDX6CQDAPSxq0z5WN1747657993.png\" width=\"139\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p> </p>\n<figure class=\"caption_element\"><img alt=\"Tibial plateau fracture C\" data-author=\"James Heilman, MD\" data-hash=\"13006\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Tibial_plateau_fracture#/media/File:TibPlatFracPlainMark.png https://en.wikipedia.org/wiki/Crus_fracture#/media/File:TibPlateauF.PNG https://en.wikipedia.org/wiki/Tibial_plateau_fracture#/media/File:TibPlateauBadMark.png\" data-tags=\"May2025\" height=\"174\" src=\"https://image.prepladder.com/notes/v4neOs3es4CRdwz6tjYF1747658010.png\" width=\"147\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p> </p>\n<ul>\n<li><strong>CT with 3D Reconstruction:</strong> Gold standard.</li>\n<li><strong>MRI:</strong> To assess <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> injuries.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Non-surgical: Stable fractures with minimal displacement.</li>\n<li>Surgical (ORIF): For displaced fractures or significant depression.</li>\n<li>Ligament <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> if needed.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 75-year-old man presents with a fracture of the intracapsular neck of the femur. What is the standard management done in this patient?", "options": [{"label": "A", "text": "Hemiarthroplasty", "correct": true}, {"label": "B", "text": "Boot and bar cast", "correct": false}, {"label": "C", "text": "Intramedullary nails", "correct": false}, {"label": "D", "text": "Russels traction", "correct": false}], "correct_answer": "A. Hemiarthroplasty", "question_images": [], "explanation_images": [], "explanation": "<table>\n<thead>\n<tr>\n<th>Aspect</th>\n<th>Details</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Common in</td>\n<td>Elderly, especially osteoporotic bones</td>\n</tr>\n<tr>\n<td>Type of fracture</td>\n<td>Intracapsular (femoral neck, within joint capsule)</td>\n</tr>\n<tr>\n<td>Risk</td>\n<td>Disruption of blood supply → <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> necrosis</td>\n</tr>\n<tr>\n<td>Goal of treatment</td>\n<td>Restore mobility, minimize complications of immobility</td>\n</tr>\n<tr>\n<td>Preferred treatment (elderly)</td>\n<td><strong>Hemiarthroplasty</strong> – replacement of <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head</td>\n</tr>\n<tr>\n<td>Preferred treatment (young)</td>\n<td>Internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> with cannulated screws or DHS</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of he following layer is affected in a Salter-Harris type 1 fracture ?", "options": [{"label": "A", "text": "Calcific zone of the growth plate", "correct": false}, {"label": "B", "text": "Hypertrophic zone of the growth plate", "correct": true}, {"label": "C", "text": "The resting zone of the growth plate", "correct": false}, {"label": "D", "text": "Through the whole of the epiphysis", "correct": false}], "correct_answer": "B. Hypertrophic zone of the growth plate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Hypertrophic or &lt;span class=\"customMeta\" data-dictid=\"3d9d9f347c1692777183a60d99394a\"&gt;calcific&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 26-year-old male presented with a proximal 1/3rd fracture of shaft of femur. What is the treatment of choice in this patient?", "options": [{"label": "A", "text": "Interlocking nail", "correct": true}, {"label": "B", "text": "Hip spica", "correct": false}, {"label": "C", "text": "Above knee slab", "correct": false}, {"label": "D", "text": "Above knee cast", "correct": false}], "correct_answer": "A. Interlocking nail", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"1f3ac88f5e169277719047640e36bf\"&gt;Interlocking&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a 70-year-old female who presents with extracapsular neck of femur fracture, what is the treatment of choice in this condition?", "options": [{"label": "A", "text": "Hemiarthroplasty", "correct": false}, {"label": "B", "text": "Boot and bar cast", "correct": false}, {"label": "C", "text": "Intramedullary nails", "correct": true}, {"label": "D", "text": "Russels traction", "correct": false}], "correct_answer": "C. Intramedullary nails", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"5b22285eec169277719026820db11c\"&gt;Intramedullary&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The diagnosis in a patient who is unable to do internal and external rotation of the hip is?", "options": [{"label": "A", "text": "Femur head fracture", "correct": false}, {"label": "B", "text": "Acetabular fractures", "correct": false}, {"label": "C", "text": "Dislocation of hip", "correct": true}, {"label": "D", "text": "Pelvis fracture", "correct": false}], "correct_answer": "C. Dislocation of hip", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/flVqeVIFc0WcMyn5K9ms1747376131.png", "https://image.prepladder.com/content/MziPIWLljrrD1MWgBgHm1747376140.png", "https://image.prepladder.com/content/j0nL8EvTInMpOGQmJv201747376152.png", "https://image.prepladder.com/content/ORCyLQSiqx62xAQ0YZBE1747376156.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:670px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Posterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Anterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of injury:</strong><br/>\n\t\t\tCaused by force along the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> with the hip flexed (e.g., <strong>dashboard injury </strong>in motor accidents).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of injury:</strong></p>\n<p>Rare injury that occurs with forced <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> and external rotation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features:</strong></p>\n<ul>\n<li>History of trauma.</li>\n<li>Pain, swelling.</li>\n<li>Deformity: <strong>flexion</strong>, <strong>adduction</strong>, <strong>internal rotation</strong>.</li>\n<li><strong>Shortening </strong>of the leg.</li>\n<li><strong>Femoral head is </strong>palpable in the <strong>gluteal </strong>region.</li>\n</ul>\n<p><strong>Radiological Features:</strong></p>\n<ul>\n<li>Femoral head displaced from the acetabulum.</li>\n<li>The thigh is internally rotated, the <span class=\"customMeta\" data-dictid=\"0404f7b31816927771912f2b470952\">lesser trochanter</span> is not seen, and Shenton’s line is broken.</li>\n<li>May require a CT scan for associated fractures.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features: </strong></p>\n<ul>\n<li>The limb appears <strong>externally rotated.</strong></li>\n<li>Possible <strong>lengthening of the affected limb </strong></li>\n<li><strong>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head </strong>is <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> in the <strong>groin</strong>.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/flVqeVIFc0WcMyn5K9ms1747376131.png\" width=\"500\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/MziPIWLljrrD1MWgBgHm1747376140.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Lorenzo Ceri, Luigi Zanna, Roberto Buzzi, Pietro De Biase\" data-hash=\"\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.sciencedirect.com/science/article/pii/S235264402100056X?via%3Dihub\" data-tags=\"\" height=\"910\" src=\"https://image.prepladder.com/content/j0nL8EvTInMpOGQmJv201747376152.png\" width=\"622\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Hip_dislocation#/media/File:HipdisX.png\" data-tags=\"\" height=\"609\" src=\"https://image.prepladder.com/content/ORCyLQSiqx62xAQ0YZBE1747376156.png\" width=\"622\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which muscle is attached to lesser trochanter?", "options": [{"label": "A", "text": "Piriformis", "correct": false}, {"label": "B", "text": "Psoas minor", "correct": false}, {"label": "C", "text": "Obturator internus", "correct": false}, {"label": "D", "text": "Psoas major muscle", "correct": true}], "correct_answer": "D. Psoas major muscle", "question_images": ["https://image.prepladder.com/content/YfxyJ3qYjeStlWqjX2iv1747376641.png"], "explanation_images": ["https://image.prepladder.com/content/9icfr9oj9piB0g4dLhgg1747376656.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Hip <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">Flexor</span> Muscle</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Origin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Attachment</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Function</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Iliopsoas (Psoas major + Iliacus)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Psoas major: Transverse processes of T12-L5 vertebrae</li>\n<li>Iliacus: <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">Iliac</span> <span class=\"customMeta\" data-dictid=\"30a1ba21881692777203de4e7b8537\">fossa</span> of the pelvis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Both muscles combine and attach at the <span class=\"customMeta\" data-dictid=\"0404f7b31816927771912f2b470952\">lesser trochanter</span> of the femur</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Primary hip flexor</li>\n<li>Flexion of the hip joint</li>\n<li>Assists in trunk <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> (psoas)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rectus Femoris</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anterior <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> spine (AIIS) and acetabulum</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tibial <span class=\"customMeta\" data-dictid=\"3292cfbbdb169277720182a7b986e4\">tuberosity</span> via the patellar tendon</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Flexion of the hip</li>\n<li>Extends the knee</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sartorius</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anterior superior <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> spine (ASIS)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Medial surface of the <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> (Pes anserinus)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Flexion, abduction, and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> of the hip</li>\n<li>Flexion of the knee</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tensor Fasciae Latae (TFL)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anterior part of the <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> crest</li>\n<li>Anterior superior <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> spine (ASIS)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Iliotibial band (ITB), which attaches to the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"ca4c4e935616927771849e13b0396f\">condyle</span> of the tibia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Flexion and <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> of the hip</li>\n<li>Medial <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> of the hip</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pectineus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pectineal line of the pubis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pectineal line of the femur</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Flexion and <span class=\"customMeta\" data-dictid=\"9efe7f9e921692777180ed75f4948a\">adduction</span> of the hip</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adductor Longus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pubic bone near the <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> symphysis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Medial <span class=\"customMeta\" data-dictid=\"ad3a6758111692777191fa157f6ece\">linea</span> aspera of the femur</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Flexion of the hip (when the hip is in extension)</li>\n<li>Adduction of the hip</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents in the OPD after a road traffic accident complaining of being unable to dorsiflex and evert the ankle. A X- ray was ordered by the attending physician. In addition to the observed injury on the X-ray, which gait abnormality is likely to be present in this patient?", "options": [{"label": "A", "text": "Stepping gait", "correct": true}, {"label": "B", "text": "Waddling gait", "correct": false}, {"label": "C", "text": "Circumduction gait", "correct": false}, {"label": "D", "text": "Stamping gait", "correct": false}], "correct_answer": "A. Stepping gait", "question_images": ["https://image.prepladder.com/notes/MYhgPno7zVXBBmcwzqOj1746179501.png"], "explanation_images": ["https://image.prepladder.com/notes/MYhgPno7zVXBBmcwzqOj1746179501.png", "https://image.prepladder.com/content/IxVH47ZpQMdromzwmuF81745990581.png", "https://image.prepladder.com/content/L1E77VcL4Ir8SNBKQELv1745990581.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Anatomy:</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"16b76d1d1c1692777200240efcb0e2\">terminal</span> branch of the <span class=\"customMeta\" data-dictid=\"1cb6159469169277719843ab627a07\">sciatic</span> nerve arises from the popliteal fossa.</li>\n<li><strong>Root value:</strong> L4,L5,S1 &amp; S2.</li>\n<li>Hooks around the neck of the fibula.</li>\n<li>Terminates by dividing into Superficial <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">peroneal</span> nerve &amp; Deep <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">peroneal</span> nerve</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Muscles supplied:</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Superficial <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">peroneal</span> nerve:</strong> Peroneus <span class=\"customMeta\" data-dictid=\"7ff574b4f61692777191fa536b5e6c\">longus</span> &amp; brevis (foot eversion)</li>\n<li><strong>Deep <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">peroneal</span> nerve:</strong> Peroneus tertius, Tibialis anterior, Extensor digitorum, Extensor hallucis longus.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cutaneous supply of foot:</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"480\" src=\"https://image.prepladder.com/content/IxVH47ZpQMdromzwmuF81745990581.png\" width=\"418\"/></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">peroneal</span> nerve injury:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Most common: Neck of <span class=\"customMeta\" data-dictid=\"9e7e90693316927772027cba1a6018\">fibula</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> </strong></li>\n<li>Posterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of the hip</li>\n<li>Fracture <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> condyle</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Foot drop</strong> (inability to evert)</li>\n<li><strong>High stepping <span class=\"customMeta\" data-dictid=\"053afdc7031692777187c2079a86a3\">gait</span> (Option A)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Conservative (mainstay): <span class=\"customMeta\" data-dictid=\"82bdbd3b8616927772024e0c20a19a\">Foot drop</span> splint</strong></li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"282\" src=\"https://image.prepladder.com/content/L1E77VcL4Ir8SNBKQELv1745990581.png\" width=\"267\"/></p>\n<ul>\n<li>Surgical (tendon transfer) - only done &gt;12 months of no recovery:\n\t\t\t\t<ul>\n<li>Barr’s technique</li>\n<li>Ober’s technique</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:362px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Scissoring gait</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Cerebral palsy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stepping gait</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Foot drop</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ataxic gait</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cerebellar ataxia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Circumduction <span class=\"customMeta\" data-dictid=\"053afdc7031692777187c2079a86a3\">gait</span> <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stroke</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Waddling <span class=\"customMeta\" data-dictid=\"053afdc7031692777187c2079a86a3\">gait</span> <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hip abductors palsy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stamping <span class=\"customMeta\" data-dictid=\"053afdc7031692777187c2079a86a3\">gait</span> <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tabes dorsalis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents to the orthopedic OPD with a limp and limb shortening . His X-ray is given below, What is the diagnosis?", "options": [{"label": "A", "text": "Perthes", "correct": false}, {"label": "B", "text": "SCFE", "correct": false}, {"label": "C", "text": "DDH", "correct": true}, {"label": "D", "text": "Fracture neck of femur", "correct": false}], "correct_answer": "C. DDH", "question_images": ["https://image.prepladder.com/content/58zrNUjYxwMptccR6pYf1695620955.png", "https://image.prepladder.com/content/hJFyEL82yu095NtjLQSP1695620967.png"], "explanation_images": [], "explanation": "<p>Correct Option C - DDH\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Condition</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Developmental <span class=\"customMeta\" data-dictid=\"984733db481692777186757cce6e6b\">Dysplasia</span> of the Hip (DDH)</p>\n</td>\n<td>\n<p>Abnormal development of the <span class=\"customMeta\" data-dictid=\"c28d031bd31692777189aa73411316\">hip joint</span> causing <span class=\"customMeta\" data-dictid=\"acb259200b16927771908888d1377c\">instability</span> or dislocation. It can result in a shortened leg and a limp.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Legg-Calvé-Perthes Disease</p>\n</td>\n<td>\n<p>Avascular <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head, leading to <span class=\"customMeta\" data-dictid=\"c28d031bd31692777189aa73411316\">hip joint</span> damage, limp, and leg length discrepancy.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Slipped Capital <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">Femoral</span> <span class=\"customMeta\" data-dictid=\"0fa073bd8016927771872ee5b57674\">Epiphysis</span> (SCFE)</p>\n</td>\n<td>\n<p>Displacement of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head from the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> neck, leading to a <span class=\"customMeta\" data-dictid=\"9fcdd5799c1692777191a2f2f38d56\">limp</span> and limb shortening. More common in adolescents.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Septic Arthritis</p>\n</td>\n<td>\n<p>Infection of the joint, causing pain, swelling, decreased range of motion, and limping.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Juvenile <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">Idiopathic</span> <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">Arthritis</span> (JIA)</p>\n</td>\n<td>\n<p>Chronic <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> of the joints, including the hip joint, resulting in pain, stiffness, and limping.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Osteomyelitis</p>\n</td>\n<td>\n<p>Infection of the bone, which can lead to limping, <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> pain, swelling, and <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> symptoms.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Periosteal Reaction</p>\n</td>\n<td>\n<p>A response of the <span class=\"customMeta\" data-dictid=\"ae97d0e84f169277719537f321c02b\">periosteum</span> to various conditions, such as trauma or infection, causing pain, swelling, and sometimes limb shortening.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Leg Length Discrepancy</p>\n</td>\n<td>\n<p>A difference in leg length, which can result from various causes, including <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> anomalies or previous fractures.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Fractures</p>\n</td>\n<td>\n<p>Fractures of the hip, femur, or other bones can cause limping and limb shortening.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Given below is the X ray of a newborn. What is the type of scoliosis shown in the X-ray ?", "options": [{"label": "A", "text": "Congenital scoliosis", "correct": true}, {"label": "B", "text": "Postural scoliosis", "correct": false}, {"label": "C", "text": "Infantile scoliosis", "correct": false}, {"label": "D", "text": "Degenerative scoliosis", "correct": false}], "correct_answer": "A. Congenital scoliosis", "question_images": ["https://image.prepladder.com/content/HkYga4Kv6hISP288XVw51688456112.png"], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\"&gt;Congenital&lt;/span&gt; S\n<table>\n<tbody>\n<tr>\n<td>\n<p>Idiopathic Scoliosis</p>\n</td>\n<td>\n<p>Infantile <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> scoliosis: develops in children younger than 3 years old.</p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p>Juvenile <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> scoliosis: develops between 3 and 10 years old.</p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p>Adolescent <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> scoliosis: develops between 10 and 18 years old.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Congenital Scoliosis</p>\n</td>\n<td>\n<p>Present at birth, resulting from <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> development during <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> development.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Neuromuscular Scoliosis</p>\n</td>\n<td>\n<p>Associated with underlying <span class=\"customMeta\" data-dictid=\"8b19cd5e161692777193ad958e52e0\">neuromuscular</span> conditions (e.g., cerebral palsy, <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> dystrophy).</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Degenerative Scoliosis</p>\n</td>\n<td>\n<p>Develops later in life due to degenerative changes in the spine.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Syndromic Scoliosis</p>\n</td>\n<td>\n<p>Associated with specific genetic syndromes or conditions.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Secondary Scoliosis</p>\n</td>\n<td>\n<p>Develops as a result of other underlying factors (e.g., tumors, infections, previous surgeries).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old female patient came with a flexion contracture of the hip. Which of the following test is useful in diagnosis?", "options": [{"label": "A", "text": "Allen's test", "correct": false}, {"label": "B", "text": "Trendelenburg test", "correct": false}, {"label": "C", "text": "Thomas test", "correct": true}, {"label": "D", "text": "Ober test", "correct": false}], "correct_answer": "C. Thomas test", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/6nd9i3mXYf6IVMbIMwkE1748208178.png", "https://image.prepladder.com/content/yYXsRyxzX4wXAspfRYwj1748208193.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is true regarding the scar tissue in patellar clunk syndrome?", "options": [{"label": "A", "text": "Superior pole of the patella, impinging during flexion", "correct": false}, {"label": "B", "text": "Superior pole of the patella, impinging during extension", "correct": true}, {"label": "C", "text": "Inferior pole of the patella, impinging during flexion", "correct": false}, {"label": "D", "text": "Inferior pole of the patella, impinging during extension", "correct": false}], "correct_answer": "B. Superior pole of the patella, impinging during extension", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 79 yrs old lady had a fall in the bathroom, the following X-rays were taken in order to make a diagnosis . Which of the following is treatment of this condition?", "options": [{"label": "A", "text": "Hemiarthroplasty", "correct": true}, {"label": "B", "text": "Hip spica", "correct": false}, {"label": "C", "text": "Total Hip Replacement", "correct": false}, {"label": "D", "text": "Nailing", "correct": false}], "correct_answer": "A. Hemiarthroplasty", "question_images": ["https://image.prepladder.com/content/H9stkGvqCzIcl5EvY1OV1695620895.png", "https://image.prepladder.com/content/ZgdEdMpEZM3VMq1vPXGT1700226697.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Hemiarth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Blount Disease results from the involvement of", "options": [{"label": "A", "text": "Proximal tibia", "correct": true}, {"label": "B", "text": "Distal tibia", "correct": false}, {"label": "C", "text": "Proximal femur", "correct": false}, {"label": "D", "text": "Distal femur", "correct": false}], "correct_answer": "A. Proximal tibia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Proximal T\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old patient presents to the emergency department following a road traffic accident. The radiograph of his pelvis is shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Central dislocation of the hip", "correct": false}, {"label": "B", "text": "Fracture shaft of femur", "correct": false}, {"label": "C", "text": "Posterior dislocation of the hip", "correct": true}, {"label": "D", "text": "Anterior dislocation of the hip", "correct": false}], "correct_answer": "C. Posterior dislocation of the hip", "question_images": ["https://image.prepladder.com/content/S3zaZ7stUxHQCTu2q3IK1713873315.png"], "explanation_images": ["https://image.prepladder.com/content/fo7pFS6h0buGjcZYVd9z1713873116.png"], "explanation": "<p>Correct Option C - Posterior &lt;span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\"&gt;dislocation&lt;/span&gt; of the h\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the shown image", "options": [{"label": "A", "text": "Ankle knee stabilizer", "correct": false}, {"label": "B", "text": "Patella tendon bearing brace", "correct": true}, {"label": "C", "text": "Thomas splint", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "B. Patella tendon bearing brace", "question_images": ["https://image.prepladder.com/content/XOOFaD3RMOyQR2TLbr261700134974.png"], "explanation_images": ["https://image.prepladder.com/content/hOGJFmiN1rggxBNjwnR71700135070.png", "https://image.prepladder.com/content/S8CY3hVhGhF17ipAfJo81700135120.png"], "explanation": "<p>Correct Option B - Patella &lt;span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\"&gt;Tendon&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"2bb6ddacfd169277718230a816b21f\"&gt;Bearing&lt;/span&gt; B\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Type</strong></p>\n</td>\n<td>\n<p><strong>Use/Indication</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ankle Brace</p>\n</td>\n<td>\n<p>Ankle sprains, instability, post-injury protection</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Knee Brace</p>\n</td>\n<td>\n<p>Ligament injuries (ACL, PCL, MCL, LCL), <span class=\"customMeta\" data-dictid=\"4560fde2ec16927771944a8ef8c066\">patellofemoral</span> pain, osteoarthritis</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Cervical Collar</p>\n</td>\n<td>\n<p>Cervical spine injuries, neck pain, whiplash</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hip <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">Abduction</span> Orthosis</p>\n</td>\n<td>\n<p>Hip fractures, hip dislocations, post-surgical stabilization</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Knee Immobilizer</p>\n</td>\n<td>\n<p>Knee fractures, <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> injuries, post-surgical immobilization</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Back Brace</p>\n</td>\n<td>\n<p>Low back pain, <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> fractures, post-surgical support</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Posterior Leg Splint</p>\n</td>\n<td>\n<p>Tibia or <span class=\"customMeta\" data-dictid=\"9e7e90693316927772027cba1a6018\">fibula</span> fractures, post-injury immobilization</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Air Cast</p>\n</td>\n<td>\n<p>Ankle fractures, sprains, post-injury protection</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Patellar Stabilizing Brace</p>\n</td>\n<td>\n<p>Patellar instability, <span class=\"customMeta\" data-dictid=\"4560fde2ec16927771944a8ef8c066\">patellofemoral</span> pain syndrome, patellar tendonitis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Avascular necrosis of the femur head is due to which of the following artery?", "options": [{"label": "A", "text": "Medial circumflex femoral artery", "correct": true}, {"label": "B", "text": "Lateral circumflex femoral artery", "correct": false}, {"label": "C", "text": "Obturator artery", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Medial circumflex femoral artery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/W5bnLRFpCbm9EYsRwx6Z1687159920.png", "https://image.prepladder.com/content/W5bnLRFpCbm9EYsRwx6Z1687159920.png"], "explanation": "<p>Correct Option A - Medial &lt;span class=\"customMeta\" data-dictid=\"ed0b0613a81692777184dc4b974a19\"&gt;Circumflex&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\"&gt;Femoral&lt;/span&gt; A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Football player gets blow to the outer knee during match. Which structure is most commonly associated with this type of injury?", "options": [{"label": "A", "text": "Anterior cruciate ligament", "correct": false}, {"label": "B", "text": "Medial collat ligament", "correct": true}, {"label": "C", "text": "Posterior Cruciate ligament", "correct": false}, {"label": "D", "text": "Lateral lemniscus", "correct": false}], "correct_answer": "B. Medial collat ligament", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Clinical History</strong></p>\n</td>\n<td>\n<p><strong>Ligaments Commonly Injured</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Valgus stress injury</p>\n</td>\n<td>\n<p>Medial <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (MCL)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hyperextension injury</p>\n</td>\n<td>\n<p>Posterior <span class=\"customMeta\" data-dictid=\"0faa43e76516927771851bff22a1e2\">cruciate</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (PCL)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pivot shift mechanism</p>\n</td>\n<td>\n<p>Anterior <span class=\"customMeta\" data-dictid=\"0faa43e76516927771851bff22a1e2\">cruciate</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (ACL)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Direct blow to the knee</p>\n</td>\n<td>\n<p>Anterior <span class=\"customMeta\" data-dictid=\"0faa43e76516927771851bff22a1e2\">cruciate</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (ACL), <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">Medial</span> <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (MCL), <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> <span class=\"customMeta\" data-dictid=\"0faa43e76516927771851bff22a1e2\">cruciate</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (PCL), <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (LCL)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Rotational force injury</p>\n</td>\n<td>\n<p>Anterior <span class=\"customMeta\" data-dictid=\"0faa43e76516927771851bff22a1e2\">cruciate</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (ACL), <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">Medial</span> <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (MCL), <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> <span class=\"customMeta\" data-dictid=\"0faa43e76516927771851bff22a1e2\">cruciate</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (PCL), <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (LCL), <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">Medial</span> meniscus, <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> meniscus</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Evaluate the following statements with respect to inter – trochanteric fracture , and opt for the correct ones : More common in males than females One – year mortality rate is about 20 to 30% It is more commonly associated with non – union than fracture neck of femur One year mortality rate can be reduced by operating within 48 hours", "options": [{"label": "A", "text": "1 and 3 are correct", "correct": false}, {"label": "B", "text": "1, 2, 3 are correct", "correct": false}, {"label": "C", "text": "2 and 4 correct", "correct": true}, {"label": "D", "text": "1, 2, 3, 4 are correct", "correct": false}], "correct_answer": "C. 2 and 4 correct", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old male has been suffering from a progressive lower backache and early morning stiffness for the past six months. His symptoms are more severe in the morning and improve with exercise. He is a known case of ulcerative colitis. An X-ray of his lumbar spine is given below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Pott’s spine", "correct": false}, {"label": "B", "text": "Psoriatic arthritis", "correct": false}, {"label": "C", "text": "Ankylosing spondylitis", "correct": true}, {"label": "D", "text": "Rheumatoid arthritis", "correct": false}], "correct_answer": "C. Ankylosing spondylitis", "question_images": ["https://image.prepladder.com/content/pQkVH7Gp4ykzg8kX8fF81713871879.png"], "explanation_images": [], "explanation": "<p>Correct Option C - Ankylosing\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Ankylosing spondylitis </strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Psoriatic arthritis </strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Rheumatoid arthritis </strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Predominant joints affected</p>\n</td>\n<td>\n<p>Spine and <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joints<br/>\n\t\t\t </p>\n</td>\n<td>\n<p>Peripheral joints<br/>\n\t\t\t </p>\n</td>\n<td>\n<p>Small joints of hands and feet</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Radiographic findings</p>\n</td>\n<td>\n<p>Sacroiliitis, erosions, or <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> of the spine<br/>\n\t\t\t </p>\n</td>\n<td>\n<p>Joint space narrowing, bone erosions, bone proliferation<br/>\n\t\t\t </p>\n</td>\n<td>\n<p>Joint space narrowing, bone erosions</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Association with other comorbidities</p>\n</td>\n<td>\n<p>Inflammatory <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease</p>\n</td>\n<td>\n<p>Psoriasis, uveitis</p>\n</td>\n<td>\n<p>Sjogren's syndrome, <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> erythematosus</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pattern of joint involvement</p>\n</td>\n<td>\n<p>Symmetric, may affect entire spine</p>\n</td>\n<td>\n<p>Symmetric or asymmetric, <span class=\"customMeta\" data-dictid=\"806f0389c516927771851ea84ecf34\">dactylitis</span> common</p>\n</td>\n<td>\n<p>Symmetrical involvement of small joints of hands and feet</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young patient presented to the emergency department with pain and swelling of the right knee . A plain radiograph is shown below. What is the best treatment for this condition?", "options": [{"label": "A", "text": "Tension band wiring with K-wires", "correct": true}, {"label": "B", "text": "Tension band wiring with cancellous screws", "correct": false}, {"label": "C", "text": "Cylinder cast", "correct": false}, {"label": "D", "text": "Patellectomy", "correct": false}], "correct_answer": "A. Tension band wiring with K-wires", "question_images": ["https://image.prepladder.com/content/4LEzNAvSkXlOiBztVnii1713871798.png"], "explanation_images": ["https://image.prepladder.com/content/XKYfSZPOuu9hV3rlcvyI1714477153.png"], "explanation": "<p>Correct Option A - Tension band &lt;span class=\"customMeta\" data-dictid=\"6ef263e89e169277720230becfc5ec\"&gt;wiring&lt;/span&gt; with K\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 14-year-old patient presents to the outpatient department with a noticeable deformity of the neck and upper back. On physical examination, the patient's scapula is observed to be elevated and medially rotated, giving it the appearance of an equilateral triangle. The patient also has limited neck mobility. The patient and their family report that the deformity has been present since birth and has not improved over time. What is the likely diagnosis for this patient's condition?", "options": [{"label": "A", "text": "Separated shoulder deformity", "correct": false}, {"label": "B", "text": "Torticollis", "correct": false}, {"label": "C", "text": "Klippel-Feil deformity", "correct": true}, {"label": "D", "text": "Congenital scoliosis", "correct": false}], "correct_answer": "C. Klippel-Feil deformity", "question_images": ["https://image.prepladder.com/content/REnoPVf63k1liU1dMQOW1693230697.png"], "explanation_images": ["https://image.prepladder.com/content/x8zPYVbVIIXZCH1vDDBP1711626266.png"], "explanation": "<p>Correct option C - Klippel-F\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old patient has limited hip movement and complains of pain and discomfort in the hip region . Which of the following test is done to identify flexion deformity at the hip?", "options": [{"label": "A", "text": "Thomas test", "correct": true}, {"label": "B", "text": "Lasegue test", "correct": false}, {"label": "C", "text": "Telescopy", "correct": false}, {"label": "D", "text": "McMurray test", "correct": false}], "correct_answer": "A. Thomas test", "question_images": ["https://image.prepladder.com/content/RKNmJxtpktag1tXy0ne41692879330.png"], "explanation_images": ["https://image.prepladder.com/content/RKNmJxtpktag1tXy0ne41692879330.png"], "explanation": "<p>Correct option A - Th\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 63 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 23</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Lower Limb Traumatology-Spine Pelvis And Lower Limb Traumatology-I - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 23</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 23 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "The pelvis of a 20-year-old female is being evaluated after a road traffic injury. The X-ray image is as follows: Which of the following would be true about the presentation of the affected limb in this case? Externally rotated Shortening of limb Adduction Internal rotation Lengthening of limb", "options": [{"label": "A", "text": "3, 4, and 5", "correct": false}, {"label": "B", "text": "2, 3, and 4", "correct": true}, {"label": "C", "text": "1, 2, and 3", "correct": false}, {"label": "D", "text": "1 and 5", "correct": false}], "correct_answer": "B. 2, 3, and 4", "question_images": ["https://image.prepladder.com/content/c7plv7ANmCgyFwLBJSgM1738309562.png"], "explanation_images": ["https://image.prepladder.com/content/924npW2BZ3Da0FYTytk21738309640.png", "https://image.prepladder.com/content/7NM4lNj7qfBjnOarrJ3S1738309662.png", "https://image.prepladder.com/content/56xM9guCMwMmbJsVdC8s1738309757.png", "https://image.prepladder.com/content/yJlXYdxx08nVhDhuw8jW1738309813.png", "https://image.prepladder.com/content/Bwi0OTIIN49Z2t5IHdmJ1738309882.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:722px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Central <span class=\"customMeta\" data-dictid=\"1954a47dd6169277720351aed9c4c0\">fracture-dislocation</span> of hip </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Mechanism of injury:</strong><br/>\n\t\t\t </p>\n<p>Caused by force along the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> with the hip flexed (e.g., <strong>dashboard injury </strong>in motor accidents).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of injury:</strong></p>\n<p>Rare injury that occurs with forced <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> and external rotation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of injury: </strong></p>\n<p>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head is driven through the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> wall of the <span class=\"customMeta\" data-dictid=\"58112da05c1692777180028ce828fa\">acetabulum</span> into the <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> cavity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features:</strong></p>\n<ul>\n<li>History of trauma.</li>\n<li>Pain, swelling.</li>\n<li>Deformity: <strong>flexion</strong>, <strong>adduction</strong>, <strong>internal rotation</strong>.</li>\n<li><strong>Shortening </strong>of the leg.</li>\n<li><strong>Femoral head is </strong>palpable in the <strong>gluteal </strong>region.</li>\n</ul>\n<p><strong>Radiological Features:</strong></p>\n<ul>\n<li>Femoral head displaced from the acetabulum.</li>\n<li>The thigh is internally rotated, the <span class=\"customMeta\" data-dictid=\"0404f7b31816927771912f2b470952\">lesser trochanter</span> is not seen, and Shenton’s line is broken.</li>\n<li>May require a <span class=\"customMeta\" data-dictid=\"871577be5e169277718596f7614659\">CT scan</span> for associated fractures.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features: </strong></p>\n<ul>\n<li>The limb appears <strong>externally rotated.</strong></li>\n<li>Possible <strong>lengthening </strong><strong>of the affected limb </strong></li>\n<li><strong>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head </strong>is <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> in the <strong>groin</strong>.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features:</strong></p>\n<ul>\n<li>Varying <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> is seen.</li>\n<li>Joint <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> and <span class=\"customMeta\" data-dictid=\"720567fecd169277719411dda3d1a2\">osteoarthritis</span> are very likely.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/924npW2BZ3Da0FYTytk21738309640.png\" width=\"4167\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/7NM4lNj7qfBjnOarrJ3S1738309662.png\" width=\"4167\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Hip_dislocation#/media/File:HipdisX.png\" data-tags=\"\" height=\"910\" src=\"https://image.prepladder.com/content/56xM9guCMwMmbJsVdC8s1738309757.png\" width=\"622\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Lorenzo Ceri, Luigi Zanna, Roberto Buzzi, Pietro De Biase\" data-hash=\"\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.sciencedirect.com/science/article/pii/S235264402100056X?via%3Dihub\" data-tags=\"\" height=\"776\" src=\"https://image.prepladder.com/content/yJlXYdxx08nVhDhuw8jW1738309813.png\" width=\"792\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Samir Benoudina\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/central-fracture-dislocation-of-the-acetabulum-2\" data-tags=\"\" height=\"776\" src=\"https://image.prepladder.com/content/Bwi0OTIIN49Z2t5IHdmJ1738309882.png\" width=\"1054\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/qcKrEsZJPmYMshKNpVMB1745751871.mp3", "video": ""}, {"text": "A 30-year-old man falls on his knees and comes with complaints of pain, swelling, and abrasions over his right knee. His X-ray shows as follows: Which of the following statements is true about the management of this type of patellar fracture?", "options": [{"label": "A", "text": "A plaster cylinder or extension brace is used primarily for 3-4 weeks", "correct": false}, {"label": "B", "text": "Open reduction and fixation are recommended methods of treatment", "correct": true}, {"label": "C", "text": "A range-of-motion brace is used after 2 weeks", "correct": false}, {"label": "D", "text": "The fracture is repaired using the tension band principle", "correct": false}], "correct_answer": "B. Open reduction and fixation are recommended methods of treatment", "question_images": ["https://image.prepladder.com/content/SgvFpnlIo0iyKV2McQ7E1738311790.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:687px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Undisplaced or minimally displaced fractures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Generally, the <span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\">extensor</span> mechanism is<strong> intact</strong>.</li>\n<li><strong>Treatment</strong>:\n\t\t\t\t<ul>\n<li>Use a <span class=\"customMeta\" data-dictid=\"6c22f2390016927771955c0c04b851\">plaster</span> <span class=\"customMeta\" data-dictid=\"ba2a9140961692777185aae938c18b\">cylinder</span> or extension <span class=\"customMeta\" data-dictid=\"ea9813b91c169277718305c8fe4777\">brace</span> to keep the knee straight for 3–4 weeks. <strong>(Option A)</strong></li>\n<li>Perform daily <span class=\"customMeta\" data-dictid=\"175fd4b3061692777196c7f28a4c53\">quadriceps</span> exercises.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Longitudinal fractures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Extensor mechanism is<strong> nearly intact</strong>, allowing for early movement.</li>\n<li><strong>Treatment</strong>:\n\t\t\t\t<ul>\n<li>Start with an extension <span class=\"customMeta\" data-dictid=\"ea9813b91c169277718305c8fe4777\">brace</span> or <span class=\"customMeta\" data-dictid=\"6c22f2390016927771955c0c04b851\">plaster</span> cylinder.</li>\n<li>Transition to a range-of-motion <span class=\"customMeta\" data-dictid=\"ea9813b91c169277718305c8fe4777\">brace</span> after 2 weeks. <strong>(Option C)</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Comminuted (stellate) fractures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Extensor expansions are <strong>intact,</strong> but there’s a risk of <span class=\"customMeta\" data-dictid=\"4560fde2ec16927771944a8ef8c066\">patellofemoral</span> joint damage.</li>\n<li><strong>Treatment</strong>:\n\t\t\t\t<ul>\n<li>Open reduction and <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> are recommended. Remove small fragments that distort the <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> surface if necessary.</li>\n<li>Use K-wires, <span class=\"customMeta\" data-dictid=\"47590a88fc16927771921cd403b9b2\">mini</span> fragment screws, <span class=\"customMeta\" data-dictid=\"13508a2eb21692777184b37534a0ae\">cerclage</span> wires, or sutures.</li>\n<li>Employ a hinged <span class=\"customMeta\" data-dictid=\"ea9813b91c169277718305c8fe4777\">brace</span> for extension and unlock it for exercises.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Displaced <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> fractures </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Entire <span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\">extensor</span> mechanism is <strong>disrupted</strong>.</li>\n<li><strong>Treatment</strong>:\n\t\t\t\t<ul>\n<li>Operative intervention is essential. <strong> </strong></li>\n<li>Expose the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> through a <span class=\"customMeta\" data-dictid=\"7ba18aa5e616927771918a45051a40\">longitudinal</span> <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> and repair using the <strong>tension-band principle</strong>.<strong> (Option D) </strong></li>\n<li>Reduce and <span class=\"customMeta\" data-dictid=\"755e6740de1692777200fbc584582e\">transfix</span> fragments with stiff K-wires, securing them with flexible wire.</li>\n<li>Repair <span class=\"customMeta\" data-dictid=\"1717bdb5d21692777200d45e31ceed\">tears</span> in the <span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\">extensor</span> expansions.</li>\n<li>Use a <span class=\"customMeta\" data-dictid=\"6c22f2390016927771955c0c04b851\">plaster</span> back-slab or hinged <span class=\"customMeta\" data-dictid=\"ea9813b91c169277718305c8fe4777\">brace</span> until active knee extension is regained, with daily removal for <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> exercises.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/pcIyAexC3uknsREIZ9GB1743243099.mp3", "video": ""}, {"text": "A 12-year-old boy who recently started playing football complains of mild knee pain in both knees following each game. Over the past few weeks, the pain has progressively worsened, becoming constant even during rest, prompting his parents to seek medical advice. There is no history of direct trauma to the knees. An X-ray reveals characteristic findings. What is the most appropriate initial management for this condition?", "options": [{"label": "A", "text": "Surgical removal of the accessory patellar fragment", "correct": false}, {"label": "B", "text": "Rest, activity modification, and strengthening exercises", "correct": true}, {"label": "C", "text": "Corticosteroid injections into the knee", "correct": false}, {"label": "D", "text": "Complete knee immobilization with a cast", "correct": false}], "correct_answer": "B. Rest, activity modification, and strengthening exercises", "question_images": ["https://image.prepladder.com/content/OYYO2nbj5Tjdt6AwyLZ31738311994.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> condition where the <span class=\"customMeta\" data-dictid=\"615557ed3a169277719497f86e830b\">patella</span> (kneecap) is divided into two separate bone segments.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Failure of <span class=\"customMeta\" data-dictid=\"3be8c9fc131692777194e15d6aeef3\">ossification</span> centers to <span class=\"customMeta\" data-dictid=\"30bdb5481f1692777203cbadf50a71\">fuse</span> during development, resulting in separate bone fragments.</li>\n<li>Occurs in approximately 1-2% of the population, often bilateral.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anatomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically involves the <span class=\"customMeta\" data-dictid=\"372f8a661016927771993a9755d398\">superolateral</span> corner of the patella.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Based on the location of the secondary <span class=\"customMeta\" data-dictid=\"3be8c9fc131692777194e15d6aeef3\">ossification</span> centre,</p>\n<ul>\n<li>Type I: <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">Inferior</span> pole of patella.</li>\n<li>Type II: <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> margin.</li>\n<li>Type III: <span class=\"customMeta\" data-dictid=\"372f8a661016927771993a9755d398\">Superolateral</span> (most common).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually asymptomatic, but can cause <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> knee pain, especially after trauma or repetitive stress.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>X-ray: Shows the <span class=\"customMeta\" data-dictid=\"615557ed3a169277719497f86e830b\">patella</span> with a well-corticated fragment.</p>\n<p>MRI: Useful for assessing associated soft tissue injury or bone <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> if symptomatic.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Patellar <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> (differs by smooth, rounded edges in <span class=\"customMeta\" data-dictid=\"fbe4520a1316927771830df0903b72\">bipartite</span> <span class=\"customMeta\" data-dictid=\"615557ed3a169277719497f86e830b\">patella</span> vs sharp edges in fractures).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Asymptomatic: No treatment required.</li>\n<li>Symptomatic: Rest, NSAIDs, physical therapy, or in severe cases, surgery (excision of fragment).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/BrzTAHKBWau4RP7bXE8K1743242715.mp3", "video": ""}, {"text": "A 28-year-old man slipped on a wet staircase and injured his foot by hitting the edge of the stairs. An X-ray reveals the following findings. Which muscle is likely involved in the avulsion seen on the X-ray?", "options": [{"label": "A", "text": "Tibialis anterior", "correct": false}, {"label": "B", "text": "Peroneus longus", "correct": false}, {"label": "C", "text": "Peroneus brevis", "correct": true}, {"label": "D", "text": "Flexor digitorum longus", "correct": false}], "correct_answer": "C. Peroneus brevis", "question_images": ["https://image.prepladder.com/content/3dhSEuNIrpiuA6RnRZKg1738312180.png"], "explanation_images": ["https://image.prepladder.com/content/UA22UjgHkVn05l9mGapz1738312247.png", "https://image.prepladder.com/content/B3gPEzJbaF0psyryteMp1738312357.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:676px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <strong>fracture</strong> of the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <strong>metadiaphyseal <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> of the fifth <span class=\"customMeta\" data-dictid=\"b7f1b05b6d1692777192a18bc2396f\">metatarsal</span> bone</strong>, about 1.5 cm <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> to the tuberosity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of Injury</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Caused by sudden, forceful <span class=\"customMeta\" data-dictid=\"94fdb58dbf16927771904508108f50\">inversion</span> or twisting of the foot.</p>\n<p>Common in athletes involved in cutting, pivoting, or <span class=\"customMeta\" data-dictid=\"8619a9e3bd169277719087f375dbc0\">jumping</span> sports.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Role of Peroneus Brevis Tendon</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The peroneus brevis <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> attaches to the <span class=\"customMeta\" data-dictid=\"3292cfbbdb169277720182a7b986e4\">tuberosity</span> and pulls on the 5th metatarsal, contributing to the <span class=\"customMeta\" data-dictid=\"954dd74f031692777182664659765f\">avulsion</span> nature of this injury.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Differentiation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Jones Fracture:</strong></p>\n<p>Occurs at the metaphyseal-diaphyseal <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> (1.5 cm from the tuberosity); less likely to heal on its own due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> blood supply.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pseudo-Jones Fracture:</strong></p>\n<p>Avulsion <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> involving the <span class=\"customMeta\" data-dictid=\"3292cfbbdb169277720182a7b986e4\">tuberosity</span> (below 1.5 cm)/base of 5th metatarsal; heals more easily due to better blood supply.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pain on the outer side of the foot, especially when walking or standing.</li>\n<li>Swelling, bruising, and <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> at the base of the 5th metatarsal.</li>\n<li>Unable to bear weight on the affected foot due to pain and instability.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray:</strong> <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> or <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> confirms the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> at the base of the 5th metatarsal.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Initial Treatment: <span class=\"customMeta\" data-dictid=\"3024d9916e16927771896f5b7159b6\">Immobilization</span> with a below-knee slab for non-displaced, stable fractures.</p>\n<p>Unstable Fracture/Nonunion: <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> intervention (e.g., K-wire fixation) is necessary for unstable fractures or fractures with nonunion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Healing and Recovery</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Non-weight-bearing:</strong> Patients should avoid <span class=\"customMeta\" data-dictid=\"2bb6ddacfd169277718230a816b21f\">bearing</span> weight on the affected foot for 45 days to promote healing.</li>\n<li><strong>Return to activity: </strong>Gradual return to activity is recommended, beginning with minimal weight-bearing and progressing as <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> allows.</li>\n<li><strong>Charlie Chaplin's Walk:</strong> Encourages patients to shift weight toward the 1st metatarsal, mimicking the waddling <span class=\"customMeta\" data-dictid=\"053afdc7031692777187c2079a86a3\">gait</span> of Charlie Chaplin to reduce pressure on the 5th metatarsal.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Delayed Union/Nonunion: </strong>Healing can be slow or incomplete due to limited blood supply at the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> site.</li>\n<li><strong>Refracture: </strong>Risk of reinjury if the patient returns to activity too soon.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>With proper treatment and <span class=\"customMeta\" data-dictid=\"5f8b7d103016927771806be7e4190b\">adherence</span> to non-weight-bearing instructions, most Jones fractures heal within 6-8 weeks.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/tieudaJkRvFF0XhZ0Zej1743242573.mp3", "video": ""}, {"text": "An increased Insall-Salvati ratio &amp;gt; 1.2 suggests which of the following clinical findings?", "options": [{"label": "A", "text": "Patella alta", "correct": true}, {"label": "B", "text": "Patella baja", "correct": false}, {"label": "C", "text": "Patellar tendon rupture", "correct": false}, {"label": "D", "text": "Bipartite patella", "correct": false}], "correct_answer": "A. Patella alta", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:638px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recurrent <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of the <span class=\"customMeta\" data-dictid=\"615557ed3a169277719497f86e830b\">patella</span> from its normal position. Typically occurs on the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> side of the knee and refers to <span class=\"customMeta\" data-dictid=\"615557ed3a169277719497f86e830b\">patella</span> dislocating multiple times.</p>\n\t\t\t \n\n\t\t\t<ul>\n<li>Recurrent dislocation: 2-3 episodes of patellar dislocation.</li>\n<li>Habitual dislocation: Occurs with every <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> and extension of the knee.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Predisposing Factors:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patella Alta</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High-riding patella, increasing risk of <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> stability.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patella Baja</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low-lying patella, less common but can affect patellar tracking.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tight <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> Structures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tight <span class=\"customMeta\" data-dictid=\"4c52e41aa91692777189b7b8847c4f\">iliotibial</span> band or <span class=\"customMeta\" data-dictid=\"dc508a511c1692777201573a224e0e\">vastus</span> <span class=\"customMeta\" data-dictid=\"130e8b9d6316927771915f03326b51\">lateralis</span> pulls the <span class=\"customMeta\" data-dictid=\"615557ed3a169277719497f86e830b\">patella</span> laterally; commonly seen in conditions like poliomyelitis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genu Valgum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased Q angle, leading to greater <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> pressure on the patella.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genu Recurvatum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperextension of the knee, increasing instability.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong><em>Diagnosis:</em></strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Apprehension Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral pressure on the <span class=\"customMeta\" data-dictid=\"615557ed3a169277719497f86e830b\">patella</span> causes discomfort or apprehension, indicating instability.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray (Blumensaat's Line)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Position of <span class=\"customMeta\" data-dictid=\"615557ed3a169277719497f86e830b\">patella</span> relative to Blumensaat's Line assesses patellar Lowermost pole above the line: <span class=\"customMeta\" data-dictid=\"615557ed3a169277719497f86e830b\">Patella</span> Alta.</p>\n<ul>\n<li>Lowermost pole below the line: <span class=\"customMeta\" data-dictid=\"615557ed3a169277719497f86e830b\">Patella</span> Baja.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Insaal's Line/Salvetti Ratio</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ratio between patellar <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> length and patellar &gt;Ratio of 1: Normal.</p>\n<ul>\n<li>Ratio &gt;1: Suggests <span class=\"customMeta\" data-dictid=\"615557ed3a169277719497f86e830b\">Patella</span> Alta.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment Options:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Modified Campbell’s Operation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral release procedure to address tight <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> structures, allowing for central patellar movement.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Roux-Goldthwait Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proximal realignment of the knee <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> and <span class=\"customMeta\" data-dictid=\"175fd4b3061692777196c7f28a4c53\">quadriceps</span> to stabilize patellar tracking.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>West and Soto Hall Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Imvolves <span class=\"customMeta\" data-dictid=\"82965f497916927771944c7b678f6c\">patellectomy</span> (removal of the patella), which is reserved for cases with <span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\">extensor</span> <span class=\"customMeta\" data-dictid=\"6ef2a80e2116927771915098fa1789\">lag</span> or failure of other treatments.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/7pigqoJn44y7boLKr3WR1743242286.mp3", "video": ""}, {"text": "A 12-year-old boy who recently started playing football complains of mild knee pain in both knees following each game. Over the past few weeks, the pain has progressively worsened, becoming constant even during rest, prompting his parents to seek medical advice. There is no history of direct trauma to the knees. An X-ray reveals characteristic findings. What is the most appropriate initial management for this condition?", "options": [{"label": "A", "text": "Surgical removal of the accessory patellar fragment", "correct": false}, {"label": "B", "text": "Rest, activity modification, and strengthening exercises", "correct": true}, {"label": "C", "text": "Corticosteroid injections into the knee", "correct": false}, {"label": "D", "text": "Complete knee immobilization with a cast", "correct": false}], "correct_answer": "B. Rest, activity modification, and strengthening exercises", "question_images": ["https://image.prepladder.com/notes/aORQGbqa3CnnA0XGIOrx1745068173.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> condition where the <span class=\"customMeta\" data-dictid=\"615557ed3a169277719497f86e830b\">patella</span> (kneecap) is divided into two separate bone segments.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Failure of <span class=\"customMeta\" data-dictid=\"3be8c9fc131692777194e15d6aeef3\">ossification</span> centers to <span class=\"customMeta\" data-dictid=\"30bdb5481f1692777203cbadf50a71\">fuse</span> during development, resulting in separate bone fragments.</li>\n<li>Occurs in approximately 1-2% of the population, often bilateral.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anatomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically involves the <span class=\"customMeta\" data-dictid=\"372f8a661016927771993a9755d398\">superolateral</span> corner of the patella.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Based on the location of the secondary <span class=\"customMeta\" data-dictid=\"3be8c9fc131692777194e15d6aeef3\">ossification</span> centre,</p>\n<ul>\n<li>Type I: <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">Inferior</span> pole of patella.</li>\n<li>Type II: <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> margin.</li>\n<li>Type III: <span class=\"customMeta\" data-dictid=\"372f8a661016927771993a9755d398\">Superolateral</span> (most common).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually asymptomatic, but can cause <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> knee pain, especially after trauma or repetitive stress.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>X-ray: Shows the <span class=\"customMeta\" data-dictid=\"615557ed3a169277719497f86e830b\">patella</span> with a well-corticated fragment.</p>\n<p>MRI: Useful for assessing associated soft tissue injury or bone <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> if symptomatic.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Patellar <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> (differs by smooth, rounded edges in <span class=\"customMeta\" data-dictid=\"fbe4520a1316927771830df0903b72\">bipartite</span> <span class=\"customMeta\" data-dictid=\"615557ed3a169277719497f86e830b\">patella</span> vs sharp edges in fractures).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Asymptomatic: No treatment required.</li>\n<li>Symptomatic: Rest, NSAIDs, physical therapy, or in severe cases, surgery (excision of fragment).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/6W3wil7m6iEIoba6GuIk1745753962.mp3", "video": ""}, {"text": "A 75-year-old man presents after falling at home and sustaining a displaced femoral neck fracture. He has limited mobility and a history of chronic hip pain. What type of prosthesis, commonly used in hemiarthroplasty for this type of fracture, is illustrated below?", "options": [{"label": "A", "text": "Austin Moore Prosthesis", "correct": true}, {"label": "B", "text": "Thompson Prosthesis", "correct": false}, {"label": "C", "text": "Corail Prosthesis", "correct": false}, {"label": "D", "text": "Bipolar Hip Prosthesis", "correct": false}], "correct_answer": "A. Austin Moore Prosthesis", "question_images": ["https://image.prepladder.com/content/aDGATPWFfhuzmO8bvTkm1738312565.png"], "explanation_images": ["https://image.prepladder.com/content/Ft56D5gfo7ffa9PGjqct1738312799.png", "https://image.prepladder.com/content/AijjobJEKpkQe30BmQR91738312951.png", "https://image.prepladder.com/content/Lfz7xIrXIvbi79o8DqfL1738313016.png", "https://image.prepladder.com/content/sRVWhtVvetGufw2HzZBJ1738313055.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:570px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Austin Moore’s <span class=\"customMeta\" data-dictid=\"17d0626681169277719604432b4d27\">prosthesis</span> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thompson’s <span class=\"customMeta\" data-dictid=\"17d0626681169277719604432b4d27\">prosthesis</span> (Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fracture neck <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> with at least 1/4\" <span class=\"customMeta\" data-dictid=\"8a54f9b87f16927771830a36390bf2\">calcar</span> <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> left intact</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>For <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> neck <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> with no calcar</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neck</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Collar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone cement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not required</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Always required</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Holes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Locking mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Self-locking</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not self-locking</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Image </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Netha Hussain\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Austin_Moore_prostheses.jpg\" data-tags=\"\" height=\"3466\" src=\"https://image.prepladder.com/content/Ft56D5gfo7ffa9PGjqct1738312799.png\" width=\"4167\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"774\" src=\"https://image.prepladder.com/content/AijjobJEKpkQe30BmQR91738312951.png\" width=\"759\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fgqFgCIBVkU6SoayYxfp1745753825.mp3", "video": ""}, {"text": "A patient caught her foot on a rock while running and felt a crack in her knee. She comes to the emergency department with pain and swelling over the knee and an inability to bear weight or walk. The X-ray is as follows: What is the diagnosis in this case?", "options": [{"label": "A", "text": "Longitudinal patella fracture", "correct": false}, {"label": "B", "text": "Polar fracture of the patella", "correct": false}, {"label": "C", "text": "Transverse patella fracture", "correct": true}, {"label": "D", "text": "Stellate patella fracture", "correct": false}], "correct_answer": "C. Transverse patella fracture", "question_images": ["https://image.prepladder.com/content/m04NNiS22DOxQGpIQbts1738311284.png"], "explanation_images": ["https://image.prepladder.com/content/DyR4DZDsCbtdpGMwLxCG1738311359.png", "https://image.prepladder.com/content/0u0iVkq1SaYDLwORXKfA1738311405.png", "https://image.prepladder.com/content/MpbKxJ7EQGh9F4M6wvaR1738311447.png", "https://image.prepladder.com/content/10uAYoAMPuJgNe3CqEe61738311537.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Functions of <span class=\"customMeta\" data-dictid=\"615557ed3a169277719497f86e830b\">patella</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is a <span class=\"customMeta\" data-dictid=\"1600563e2f169277719800862d9bef\">sesamoid</span> bone that acts as a fulcrum for the <span class=\"customMeta\" data-dictid=\"175fd4b3061692777196c7f28a4c53\">quadriceps</span> and patellar tendons.</li>\n<li>It holds the <span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\">extensor</span> 'strap' away from the knee's <span class=\"customMeta\" data-dictid=\"1feb2a0a3016927771847db9449f75\">centre</span> of rotation, increasing the efficiency of the <span class=\"customMeta\" data-dictid=\"175fd4b3061692777196c7f28a4c53\">quadriceps</span> muscle.</li>\n<li>Provides stability to the <span class=\"customMeta\" data-dictid=\"9d86b5d3351692777190224c62427b\">knee joint</span> during movement.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of injury</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Direct injury </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Resulting from a <strong>fall onto the knee or impact </strong>(e.g., car dashboard), leading to:</p>\n<ul>\n<li>Undisplaced crack.</li>\n<li>Comminuted (stellate) <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> without severe damage to the <span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\">extensor</span> expansions.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indirect injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs when the <strong>foot catches an obstacle</strong> leading to:</p>\n<ul>\n<li>Forceful <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> of the <span class=\"customMeta\" data-dictid=\"175fd4b3061692777196c7f28a4c53\">quadriceps</span> muscle</li>\n<li>Typically results in a <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> with a gap between fragments</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:502px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fracture type </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transverse</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Has a <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">horizontal</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> line.</p>\n<p><img alt=\"\" data-author=\"Hellerhoff\" data-hash=\"\" data-license=\"CC-BY-SA-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Patella-Querfraktur_kaum_disloziert.png\" data-tags=\"\" height=\"910\" src=\"https://image.prepladder.com/content/DyR4DZDsCbtdpGMwLxCG1738311359.png\" width=\"654\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Longitudinal </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Has a vertical <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> line.</p>\n<p><img alt=\"\" data-author=\"Arlene Campos\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/knee-skyline-laurin-view?lang=gb\" data-tags=\"\" height=\"776\" src=\"https://image.prepladder.com/content/0u0iVkq1SaYDLwORXKfA1738311405.png\" width=\"826\"/></p>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Polar </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fracture at the upper or lower pole of the patella.</p>\n<p><img alt=\"\" data-author='\"Anthony Keeley Paul Bloomfield Peter Cairns Robert Molnar\"' data-hash=\"\" data-license=\"CC BY 2.0\" data-source=\"https://www.researchgate.net/figure/Lateral-radiograph-of-patients-knee-showing-minimally-displaced-transverse-fracture-of_fig1_26705639\" data-tags=\"\" height=\"910\" src=\"https://image.prepladder.com/content/MpbKxJ7EQGh9F4M6wvaR1738311447.png\" width=\"690\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Comminuted (stellate) </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"615557ed3a169277719497f86e830b\">patella</span> becomes multiple fragments from a high-energy impact</p>\n<p><img alt=\"\" data-author='\"Song Gao Xuqiang Liu Fengtian Zhang Min Dai\"' data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Radiographs-of-the-comminuted-patellar-fracture-A-and-B-Radiographs-after_fig1_324444324\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/10uAYoAMPuJgNe3CqEe61738311537.png\" width=\"3540\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/BLiWmQcxq61Ydm3HQ0Zb1743241239.mp3", "video": ""}, {"text": "A patient who suffered from anterior dislocation of the hip develops pain and stiffness around the joint after a few months of the injury. The X-ray image shows: Which of the following complications has developed here?", "options": [{"label": "A", "text": "Sciatic nerve injury", "correct": false}, {"label": "B", "text": "Myositis ossificans", "correct": true}, {"label": "C", "text": "Osteoarthritis", "correct": false}, {"label": "D", "text": "Avascular necrosis", "correct": false}], "correct_answer": "B. Myositis ossificans", "question_images": ["https://image.prepladder.com/content/p9VYmIcwkVCQGJwfz1mX1738310962.png"], "explanation_images": ["https://image.prepladder.com/content/QOECvYc19hBtdsjGlIvy1738311066.png", "https://image.prepladder.com/content/eB37eIA68DNy3PjqGg7w1738311121.png", "https://image.prepladder.com/content/RjEJSS20CYRTXFMdrwDY1738311162.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior hip <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Type I: <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">Pubic</span> (superior) injuries</li>\n<li>Type II: <span class=\"customMeta\" data-dictid=\"215af9957a1692777194e73b21a340\">Obturator</span> (inferior) injuries</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reduction should be performed as soon as possible under <span class=\"customMeta\" data-dictid=\"b81cee1b5f16927771987099f651a0\">sedation</span> or general anesthesia.</li>\n<li>Closed reduction technique:\n\t\t\t\t<ul>\n<li>Hold the affected leg in external rotation, abduction, and flexion.</li>\n<li>Apply <span class=\"customMeta\" data-dictid=\"7ba18aa5e616927771918a45051a40\">longitudinal</span> traction.</li>\n<li>Internally and externally <span class=\"customMeta\" data-dictid=\"ed17327223169277719753b0e5d6b4\">rotate</span> the leg until reduction is achieved, and apply <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> pressure on the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head if necessary.</li>\n<li>If repeated attempts fail, consider an open reduction.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Injury to the <strong>sciatic nerve. </strong><strong>(Option A)</strong></li>\n<li><strong>Avascular <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head </strong><strong>(Option D)</strong>: may require hip replacement if <span class=\"customMeta\" data-dictid=\"720567fecd169277719411dda3d1a2\">osteoarthritis</span> develops.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Mikael Häggström\" data-hash=\"\" data-license=\"CC0\" data-source=\"https://commons.wikimedia.org/wiki/File:X-ray_of_idiopathic_avascular_necrosis_of_the_femoral_head_-_Anteroposterior.jpg\" data-tags=\"\" height=\"776\" src=\"https://image.prepladder.com/content/QOECvYc19hBtdsjGlIvy1738311066.png\" width=\"822\"/></p>\n<p><br/>\n\t\t\t </p>\n<ul>\n<li><strong>Osteoarthritis </strong><strong>(Option C)</strong>: develops years later. Treatment varies from conservative to total hip replacement.</li>\n</ul>\n<p><img alt=\"\" data-author='\"Tom D. Turmezei Ken E. S. Poole\"' data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Marginal-osteophytes-in-a-left-hip-with-moderate-osteoarthritis-as-seen-with-a-coronal-T1_fig5_225079588\" data-tags=\"\" height=\"3070\" src=\"https://image.prepladder.com/content/eB37eIA68DNy3PjqGg7w1738311121.png\" width=\"4167\"/></p>\n<p><br/>\n\t\t\t </p>\n<ul>\n<li><strong>Myositis Ossificans</strong><strong>:</strong> Develops weeks to months post-injury and is characterized by pain and stiffness. Ill-advised vigorous and improper <span class=\"customMeta\" data-dictid=\"c515f6a71d16927771919f574f1ee9\">massage</span> following trauma is the most common cause.Treatment includes rest and analgesics.</li>\n</ul>\n<p><img alt=\"\" data-author=\"Dishanth Sivakumaran a, Kalaventhan Pathinathan a, Joy Danisious a, Gobyshanger Thayasivam b\" data-hash=\"\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.sciencedirect.com/science/article/pii/S221026122100612X?via%3Dihub\" data-tags=\"\" height=\"370\" src=\"https://image.prepladder.com/content/RjEJSS20CYRTXFMdrwDY1738311162.png\" width=\"836\"/></p>\n\t\t\t \n\n\t\t\t<ul>\n<li>Potential for associated <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head fractures.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Central <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Apply <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> traction.</li>\n<li>Traction is maintained for 8-12 weeks.</li>\n<li>If reduction of the <span class=\"customMeta\" data-dictid=\"c28d031bd31692777189aa73411316\">hip joint</span> is inadequate, a <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> trochanteric pin may be needed.</li>\n<li>Surgical <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> may be needed if fragments are not repositioned in young individuals.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hip stiffness</li>\n<li>Myositis</li>\n<li>Osteoarthritis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/HBIeJojd7ngQoymuQdYm1743241154.mp3", "video": ""}, {"text": "A 50-year-old male comes with pain at the hip, and limb deformity is noted in the supine position. He is diagnosed with a posterior hip dislocation after radiological examination and is reduced by the following method: Identify this method of reduction.", "options": [{"label": "A", "text": "Alli’s traction method", "correct": false}, {"label": "B", "text": "Stimson gravity method", "correct": true}, {"label": "C", "text": "Bigelow’s method", "correct": false}, {"label": "D", "text": "East Baltimore technique", "correct": false}], "correct_answer": "B. Stimson gravity method", "question_images": ["https://image.prepladder.com/content/kRu7gcowMlr6o1Bnr6Vg1738310394.png"], "explanation_images": ["https://image.prepladder.com/content/iYDAao9pJgnsZMPB5hIX1738310453.png", "https://image.prepladder.com/content/qIiZWiMDaLSbnAz348Jw1738310646.png", "https://image.prepladder.com/content/7tau7B0x1HQQTiIZAnPn1738310716.png", "https://image.prepladder.com/content/wBMPY7SCnl0kgHqZ8ksL1738310503.png", "https://image.prepladder.com/content/nTJbKHqAiIiMuG5rM7731738310748.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:693px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stimson gravity method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The patient lies face down with their lower legs bent at 90 degrees over the stretcher's edge.</li>\n<li>An operator applies downward pressure on the lower leg or knee, adjusting the ankle for <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> until proper <span class=\"customMeta\" data-dictid=\"3c0c325f4216927771819e5d0eb581\">alignment</span> is achieved.</li>\n<li>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/iYDAao9pJgnsZMPB5hIX1738310453.png\" width=\"4167\"/></p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alli’s <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> method</strong> <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The patient is positioned <span class=\"customMeta\" data-dictid=\"b0976ea1fd16927771995d5c700a21\">supine</span> with the knee flexed to 90 degrees.</li>\n<li>An assistant stabilizes the <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> while the operator applies traction, flexes the hip, and gently extends and externally rotates the leg to reduce the hip.</li>\n<li>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"793\" src=\"https://image.prepladder.com/content/qIiZWiMDaLSbnAz348Jw1738310646.png\" width=\"790\"/></p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bigelow’s method </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>With the <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> stabilized, the operator holds the ankle and places their <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> at the <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> knee.</li>\n<li>The hip is flexed to 90 degrees, adducted, and internally rotated.</li>\n<li>Traction is applied, then the limb is abducted, extended, and externally rotated.</li>\n<li style=\"text-align: center;\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"786\" src=\"https://image.prepladder.com/content/7tau7B0x1HQQTiIZAnPn1738310716.png\" width=\"789\"/></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>East Baltimore technique </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The operator stands on the affected side with an assistant on the opposite side.</li>\n<li>Together, they <span class=\"customMeta\" data-dictid=\"73eb6a06aa1692777202a9f27fafa2\">flex</span> and support the affected limb under the knee, stabilizing the <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> with their free hands.</li>\n<li>Traction is applied by extending the knee upward, while a third assistant holds the ankle for leverage and controls rotation, abduction, and adduction.</li>\n<li style=\"text-align: center;\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/wBMPY7SCnl0kgHqZ8ksL1738310503.png\" width=\"4167\"/></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classical Watson Jones method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>This technique works for both <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> hip dislocations.</li>\n<li>The limb is positioned neutrally, with the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head resting <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> to the acetabulum.</li>\n<li>One person stabilizes the <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> while the other applies <span class=\"customMeta\" data-dictid=\"7ba18aa5e616927771918a45051a40\">longitudinal</span> <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> to guide the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head back into place.</li>\n<li>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/nTJbKHqAiIiMuG5rM7731738310748.png\" width=\"4167\"/></p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ScnwQzwiZFLS96nIuRp61745752245.mp3", "video": ""}, {"text": "In a 45-year-old patient who was a victim of a road traffic accident, a right posterior hip dislocation is suspected. On further evaluation, the dislocation is associated with comminuted fragments of the posterior acetabular wall. According to the Thomas and Epstein classification, which type of posterior dislocation is this?", "options": [{"label": "A", "text": "Type I", "correct": false}, {"label": "B", "text": "Type III", "correct": true}, {"label": "C", "text": "Type II", "correct": false}, {"label": "D", "text": "Type V", "correct": false}], "correct_answer": "B. Type III", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/TLA6L7C0ATVvFprn5FDX1738319403.png", "https://image.prepladder.com/content/oxpS2AVviAQcIhoZvbwF1738310124.png", "https://image.prepladder.com/content/eufLdXz2rOAkOudhwd1f1738310198.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:629px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thompson and Epstein's <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">classification</span> of <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of the hip </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type I </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dislocation with no more than minor chip fractures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type II </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dislocation with a single large fragment of <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> acetabular wall</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dislocation with <span class=\"customMeta\" data-dictid=\"9c8512bb5d169277718470669bd36e\">comminuted</span> fragments of <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> acetabular wall</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dislocation with a <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> through the acetabular floor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type V </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dislocation with a <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> through the acetabular floor and <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head (the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> is further classified by Pipkin classification)</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/TLA6L7C0ATVvFprn5FDX1738319403.png\" width=\"4167\"/></td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:697px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early Complications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sciatic Nerve Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Occurs in 10–20% of cases.</li>\n<li>Nerve function must be tested before reduction.</li>\n<li>If a new <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> is diagnosed post-reduction, explore the nerve to <strong>check for entrapment.</strong></li>\n<li>Use ankle <span class=\"customMeta\" data-dictid=\"4f5917b20816927771990a45367450\">splinting</span> to prevent <strong>equinus deformity</strong> if <span class=\"customMeta\" data-dictid=\"82bdbd3b8616927772024e0c20a19a\">foot drop</span> occurs.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vascular Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Possible tearing of the <strong>superior <span class=\"customMeta\" data-dictid=\"6df580322e1692777188d0c52e5f90\">gluteal</span> artery</strong>, leading to profuse bleeding.</li>\n<li>Perform an <span class=\"customMeta\" data-dictid=\"cec677618716927771827eabc295a7\">arteriogram</span> if suspected; it may require <span class=\"customMeta\" data-dictid=\"dcfb6667ee1692777191f00c3df2df\">ligation</span> or embolization.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Fractured <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">Femoral</span> Shaft</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Can be missed if not actively sought.</li>\n<li>Requires clinical and radiographic <span class=\"customMeta\" data-dictid=\"1cc6e4677116927771870a10c66fe7\">exclusion</span> of hip injury.</li>\n<li>Difficulties in <span class=\"customMeta\" data-dictid=\"da014870171692777184980beab405\">closed reduction</span> may necessitate prompt <span class=\"customMeta\" data-dictid=\"61e4fc8326169277719471f9c16b02\">open reduction</span> followed by internal fixation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Late complications </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Osteonecrosis of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">Femoral</span> Head</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Occurs in up to 20% of cases</li>\n<li>Increases to over 40% if<strong> reduction is delayed </strong>beyond 12 hours.</li>\n<li>X-ray changes may not appear for weeks, but <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> shows changes sooner.</li>\n<li>Ischemia due to blood supply <span class=\"customMeta\" data-dictid=\"abc81e8daf1692777190c03d7842ef\">interruption</span> necessitates early reduction (ideally within 6 hours).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Myositis Ossificans</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uncommon, likely related to the<strong> severity of soft tissue injury.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Unreduced Dislocation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Closed <span class=\"customMeta\" data-dictid=\"fb84ef68cf1692777191f6e12eeebe\">manipulation</span> often fails after a few weeks, and then an <span class=\"customMeta\" data-dictid=\"61e4fc8326169277719471f9c16b02\">open reduction</span> may be needed.</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> of <strong>stiffness and osteonecrosis</strong>, potentially requiring reconstructive surgery.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Secondary Osteoarthritis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Common due to <strong>cartilage damage, retained fragments, and osteonecrosis.</strong></li>\n<li>Difficult to treat in young patients, often managed with <span class=\"customMeta\" data-dictid=\"54ac01f4f116927771829dd4d10428\">arthroplasty</span> in end-stage cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Recurrent Instability</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uncommon but may require <span class=\"customMeta\" data-dictid=\"6694ddb1db1692777199c9a1e38bf0\">stabilization</span> or delayed reconstruction.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/oD0VtwvgNsSKYUVW0ssx1743240821.mp3", "video": ""}, {"text": "A patient is being examined by the surgeon and notices that the femoral pulse is not palpable. Which of the following conditions would not be a possibility here?", "options": [{"label": "A", "text": "Anterior dislocation of hip", "correct": true}, {"label": "B", "text": "Fracture neck of femur", "correct": false}, {"label": "C", "text": "Developmental dysplasia of hip", "correct": false}, {"label": "D", "text": "Posterior dislocation of hip", "correct": false}], "correct_answer": "A. Anterior dislocation of hip", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/joRqCoE2l7CvLDIcsuoV1743240609.mp3", "video": ""}, {"text": "A 55-year-old male presents with hip pain after a fall. An X-ray of the pelvis reveals a disrupted Shenton's line as shown below. Which of the following conditions can be ruled out based on this finding?", "options": [{"label": "A", "text": "Femoral neck fracture", "correct": false}, {"label": "B", "text": "Hip dislocation", "correct": false}, {"label": "C", "text": "Intertrochanteric fracture", "correct": false}, {"label": "D", "text": "Pelvic fracture", "correct": true}], "correct_answer": "D. Pelvic fracture", "question_images": ["https://image.prepladder.com/content/mBwgO3aEGDczz43gab0M1738306670.png"], "explanation_images": ["https://image.prepladder.com/content/ZOiyFkFYIkOad9GQxYyI1738306817.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/y0lpF9VbHFdyJAP8eO4p1743232965.mp3", "video": ""}, {"text": "A 65-year-old patient presents with persistent hip pain and an inability to bear weight following a previously treated fracture of the neck of the femur. X-rays reveal signs of non-union. Which of the following treatment options is most appropriate for this patient?", "options": [{"label": "A", "text": "Pauwel’s osteotomy", "correct": false}, {"label": "B", "text": "Hemi-replacement arthroplasty", "correct": false}, {"label": "C", "text": "Inter-trochanteric osteotomy", "correct": false}, {"label": "D", "text": "Replacement arthroplasty", "correct": true}], "correct_answer": "D. Replacement arthroplasty", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/krhNXMvAeziGlsdgh67q1738309452.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications of <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> neck of <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Non-union </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Occurs in 30-40% of intra-capsular fractures.</li>\n<li>Caused by inadequate <span class=\"customMeta\" data-dictid=\"3024d9916e16927771896f5b7159b6\">immobilization</span> and poor blood supply.</li>\n<li><strong>Clinical features:</strong>\n<ul>\n<li>Pain</li>\n<li>Inability to bear weight</li>\n<li>Limb shortening</li>\n<li>External rotation</li>\n<li>Positive Trendelenburg test.</li>\n</ul>\n</li>\n<li><strong>Treatment:</strong>\n<ul>\n<li>Older patients: <strong>Replacement arthroplasty</strong>.</li>\n<li>Younger patients: Neck <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> or <strong>Pauwel's <span class=\"customMeta\" data-dictid=\"d1ed4aacdf1692777194c9aa2fc2ac\">osteotomy</span> </strong><strong>(Option A)</strong>.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Avascular necrosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Caused due to loss of <span class=\"customMeta\" data-dictid=\"0a36e18386169277719259641cf29b\">medullary</span> and capsular blood supply to the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head following a fracture.</li>\n<li>May lead to head collapse and deformation.</li>\n<li>X-ray changes are not seen until after a few months to 2 years.</li>\n<li>Diagnosed via MRI.</li>\n<li><strong>Treatment:</strong>\n<ul>\n<li>Younger patients: options include arthrodesis, <span class=\"customMeta\" data-dictid=\"df4ae006fe1692777183604169e9b2\">bipolar</span> arthroplasty, Meyer’s procedure or total hip replacement,</li>\n<li>Elderly patients:<strong> hemi-replacement <span class=\"customMeta\" data-dictid=\"54ac01f4f116927771829dd4d10428\">arthroplasty</span> </strong><strong>(Option B) </strong>or total hip replacement if needed.</li>\n</ul>\n</li>\n</ul>\n<p><img alt=\"\" data-author=\"Chris-martin \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Shf_medial_verschraubt_crop.jpg\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/krhNXMvAeziGlsdgh67q1738309452.png\" width=\"2901\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Osteoarthritis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Develops years after <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> due to <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> <span class=\"customMeta\" data-dictid=\"be89985d2716927771855cf308c204\">deformation</span> or faulty alignment.</li>\n<li><strong>Symptoms:</strong> Joint pain and stiffness, initially intermittent, then persistent.</li>\n<li><strong>Treatment:</strong>\n<ul>\n<li>Younger patients:<strong> Inter-trochanteric osteotomy</strong> <strong>(Option C) </strong>or arthrodesis.</li>\n<li>Elderly patients: Total hip replacement.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/JtIDbKCSbVoYrW2uzrf51745729710.mp3", "video": ""}, {"text": "Which of the following is not an indication for total hip replacement?", "options": [{"label": "A", "text": "Osteoarthritis", "correct": false}, {"label": "B", "text": "Septic arthritis of hip joint", "correct": true}, {"label": "C", "text": "Acute fracture of femur neck", "correct": false}, {"label": "D", "text": "Bone tumor involving acetabulum", "correct": false}], "correct_answer": "B. Septic arthritis of hip joint", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemiarthroplasty </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves replacing the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head with a <span class=\"customMeta\" data-dictid=\"17d0626681169277719604432b4d27\">prosthesis</span> while retaining the natural <span class=\"customMeta\" data-dictid=\"58112da05c1692777180028ce828fa\">acetabulum</span> and acetabular cartilage.</p>\n\t\t\t \n\n\t\t\t<p><strong>Indications: </strong></p>\n<ul>\n<li>Displaced <span class=\"customMeta\" data-dictid=\"e5c2f7896c16927771998d7eb7f8f2\">sub</span> capital neck fractures</li>\n<li>Femoral head <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> (Garden III and IV fractures)</li>\n<li>Comorbid, less active, older patients (not good <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> candidates for THR)</li>\n<li>Glenoid <a href=\"https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/dysplasia\">dysplasia</a> or bone loss</li>\n<li>Osteoarthritis (OA)</li>\n<li>Hip or <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> fracture</li>\n</ul>\n<br/>\n\t\t\t </td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Total <span class=\"customMeta\" data-dictid=\"b9a07faf0a1692777188ed6bdfb2fb\">Hemiarthroplasty</span> (THR)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves the replacement of the <span class=\"customMeta\" data-dictid=\"58112da05c1692777180028ce828fa\">acetabulum</span> in addition to the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head.</p>\n\t\t\t \n\n\t\t\t<p><strong>Indications: </strong></p>\n<ul>\n<li>Inflammatory arthritis\n\t\t\t\t<ul>\n<li>Rheumatoid</li>\n<li>Juvenile idiopathic</li>\n<li>Ankylosing spondylitis</li>\n</ul>\n</li>\n<li>Osteoarthritis <strong>(Option A)</strong></li>\n<li>Osteonecrosis</li>\n<li>Failed reconstruction\n\t\t\t\t<ul>\n<li>Osteotomy</li>\n<li>Hemiarthroplasty</li>\n<li>Resection <span class=\"customMeta\" data-dictid=\"54ac01f4f116927771829dd4d10428\">arthroplasty</span> (Girdlestone procedure)</li>\n<li>Resurfacing arthroplasty</li>\n</ul>\n</li>\n<li>Acute fracture, <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> neck, and trochanteric <strong>(Option C)</strong></li>\n<li>Nonunion, <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> neck, and trochanteric fractures</li>\n<li>Hip <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> and pseudarthrosis\n\t\t\t\t<ul>\n<li>Bone tumor involving <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> or <span class=\"customMeta\" data-dictid=\"58112da05c1692777180028ce828fa\">acetabulum</span> <strong>(Option D)</strong></li>\n<li>Hereditary disorders (e.g., achondroplasia)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/qTFgTh4dxH2aywPsoBzP1745729443.mp3", "video": ""}, {"text": "A 50-year-old male patient suffering from incapacitating osteoarthritis of the hip is being advised for a total hip replacement surgery. Which of the following is the most serious complication of this surgery?", "options": [{"label": "A", "text": "Deep vein thrombosis", "correct": false}, {"label": "B", "text": "Dislocation", "correct": false}, {"label": "C", "text": "Fat embolism", "correct": true}, {"label": "D", "text": "Infection", "correct": false}], "correct_answer": "C. Fat embolism", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/NXU0Qdb3nI5zNoF2YGMw1738308611.png", "https://image.prepladder.com/content/a4hWWzdWknRfKfYEo8o51738308740.png", "https://image.prepladder.com/content/JqRkcU0t6usgCfeSmCqs1738308829.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:761px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemiarthroplasty </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Total hip replacement </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Procedure </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Replacement of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head while leaving the <span class=\"customMeta\" data-dictid=\"58112da05c1692777180028ce828fa\">acetabulum</span> intact.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Replacement of both the <span class=\"customMeta\" data-dictid=\"58112da05c1692777180028ce828fa\">acetabulum</span> and <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head with artificial components (high-density <span class=\"customMeta\" data-dictid=\"6f2c4e308c16927771964ef7064e47\">polyethylene</span> cup and cobalt-chromium <span class=\"customMeta\" data-dictid=\"f4a165ac5e169277718113dd5e4a4d\">alloy</span> head).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Indications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fracture of the neck of <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> in the elderly.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Full non-operative treatment was attempted and failed.</li>\n<li>Incapacitating <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> (e.g., <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">rheumatoid</span> arthritis, osteoarthritis).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n<br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Types of <span class=\"customMeta\" data-dictid=\"17d0626681169277719604432b4d27\">prosthesis</span> and <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> methods </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prosthesis:</strong></p>\n<ul>\n<li><strong>Monopolar</strong>: single-piece prosthesis.</li>\n<li><strong>Bipolar</strong>: two-piece <span class=\"customMeta\" data-dictid=\"17d0626681169277719604432b4d27\">prosthesis</span> allowing motion between parts.</li>\n<li><strong>Modular</strong>: assembled from various combinations of stem and head sizes.</li>\n</ul>\n<p><strong>Fixation methods:</strong></p>\n<ul>\n<li><strong>Cemented</strong>:\n\n\t\t\t\t<ul>\n<li>Prosthesis bonded to the host bone using bone cement.</li>\n<li>Used in elderly.</li>\n</ul>\n</li>\n<li><strong>Uncemented</strong>:\n\t\t\t\t<ul>\n<li>Press-fit design for natural <span class=\"customMeta\" data-dictid=\"8de909bf2c16927771830a553b239f\">bonding</span> with host bone.</li>\n<li>Used in young patients.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Cemented</strong>: typically for elderly patients with a life <span class=\"customMeta\" data-dictid=\"9332897b901692777187ae9cd44351\">expectancy</span> of 10-15 years.</li>\n<li><strong>Uncemented</strong>: generally done for younger patients.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Complications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Intraoperative fracture</li>\n<li>Dislocation</li>\n<li>Periprosthetic fracture</li>\n<li><strong>Acetabular erosion</strong></li>\n<li>Leg-length inequality</li>\n<li>Infection</li>\n<li>Aseptic loosening</li>\n<li>Heterotrophic ossification</li>\n<li>Foot drop</li>\n<li>Deep <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> thrombosis</li>\n<li>Pulmonary embolism</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Deep <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> (DVT) </strong><strong>(Option A)</strong></li>\n<li>Nerve palsies (Rare; M/c affected nerve: <span class=\"customMeta\" data-dictid=\"1cb6159469169277719843ab627a07\">Sciatic</span> nerve)</li>\n<li><strong>Vascular injury </strong></li>\n<li>Fractures (Can occur during <span class=\"customMeta\" data-dictid=\"52007706a216927771899e36747712\">implantation</span> or due to stress concentration later)</li>\n<li><strong>Dislocation </strong><strong>(Option B)</strong>:</li>\n<li><strong>Infection</strong></li>\n<li>Heterotrophic bone formation (New bone formation around components, reducing joint movement range)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"3739\" src=\"https://image.prepladder.com/content/NXU0Qdb3nI5zNoF2YGMw1738308611.png\" width=\"3739\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Nevit Dilmen \" data-hash=\"\" data-license=\" CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Medical_X-Ray_imaging_DZB03_nevit.jpg\" data-tags=\"\" height=\"776\" src=\"https://image.prepladder.com/content/a4hWWzdWknRfKfYEo8o51738308740.png\" width=\"946\"/></td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:594px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Osteotomy </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cutting off a bone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Correct excessive angulation, bowing, or <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> of long bones.</li>\n<li>Address mal-alignment of a joint.</li>\n<li>Allow <span class=\"customMeta\" data-dictid=\"3e53f6980f1692777187044dd3f9e7\">elongation</span> or shortening of a bone for leg length inequality.</li>\n<li>Special cases, such as McMurray's osteotomy, for specific purposes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"3739\" src=\"https://image.prepladder.com/content/JqRkcU0t6usgCfeSmCqs1738308829.png\" width=\"3739\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/2DvKu1ezrkIdvdyAlNzd1743240149.mp3", "video": ""}, {"text": "Which of the following is false about the treatment of neck of femur fractures according to Garden’s classification?", "options": [{"label": "A", "text": "Garden’s type 1 is preferably treated with conservative methods and immobilization", "correct": false}, {"label": "B", "text": "Garden’s type 2 fractures need internal fixation", "correct": false}, {"label": "C", "text": "A hip spica is used in children with Garden’s type 2 fracture", "correct": true}, {"label": "D", "text": "Total hip arthroplasty is done in active older adults for Garden’s type 4 fracture", "correct": false}], "correct_answer": "C. A hip spica is used in children with Garden’s type 2 fracture", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/CQfanMchQHpODy0uSxpG1738308411.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:775px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Garden’s <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">classification</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment in adults </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment in children </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Garden’s type 1</strong></p>\n<p>(incomplete, impacted, or abducted fracture)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Conservative methods <strong>(Option A)</strong></li>\n<li>Immobilization in a Thomas <span class=\"customMeta\" data-dictid=\"7f606f911b1692777199eb69ab67c5\">splint</span> with traction</li>\n<li>Internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> with screws (if <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> is feared)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hip <span class=\"customMeta\" data-dictid=\"f2ad4340681692777199d8bf0f5cbb\">spica</span> </strong></li>\n<li>Traction is applied through a pin (Moore’s pin) or wire in older adolescents</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Garden’s type 2</strong></p>\n<p>(complete but undisplaced)</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> with cannulated screws, dynamic hip screws, <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> locking plates, and cephalomedullary nails. <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Garden’s <span class=\"customMeta\" data-dictid=\"6f809a27121692777201d1ccde5ace\">type 3</span> </strong></p>\n<p>(complete &amp; partially displaced)<strong> </strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hemiarthroplasty (done in inactive elderly of &gt;60years of age with comorbidities)</li>\n<li>Total hip <span class=\"customMeta\" data-dictid=\"54ac01f4f116927771829dd4d10428\">arthroplasty</span> (done in active older patients) <strong>(Option D)</strong></li>\n<li>Internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> (done in young adults)</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> (using Knowle’s screw)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Garden’s type 4</strong></p>\n<p>(complete &amp; fully displaced)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/rF2xYxDpTv65pCQ29XgS1743240031.mp3", "video": ""}, {"text": "Which of the following points correctly differentiates between the neck of femur fracture and intertrochanteric fracture? Intertrochanteric fractures are generally more stable and have a higher chance of conservative management. Neck of femur fractures usually occur in younger patients following high-energy trauma. Neck of femur fractures are more commonly intracapsular, while intertrochanteric fractures are extracapsular. Intertrochanteric fractures are typically associated with more blood loss compared to neck of femur fractures.", "options": [{"label": "A", "text": "Statements 1 and 3 are correct", "correct": false}, {"label": "B", "text": "Statements 2 and 4 are correct", "correct": false}, {"label": "C", "text": "Statements 3 and 4 are correct", "correct": true}, {"label": "D", "text": "All Correct", "correct": false}], "correct_answer": "C. Statements 3 and 4 are correct", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/2gH7Az1ooDj6C1hDzxM91738308198.png", "https://image.prepladder.com/content/KhKgT1Asu5U2rngTCwDN1738308247.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:737px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neck of <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">Femur</span> Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intertrochanteric Fracture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intracapsular (within the joint capsule)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extracapsular (outside the joint capsule)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically after 50 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically after 60 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Female &gt; Male</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Male &gt; Female</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Patient Demographics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elderly (low-energy trauma like falls)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elderly (low-energy trauma); rare high-energy trauma in younger patients</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trivial, low-energy trauma (osteoporotic)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low-energy trauma in elderly; usually requires significant trauma in younger patients</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stability</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less stable, especially if displaced</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generally unstable due to muscle forces and location</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ability to Walk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May be possible in <span class=\"customMeta\" data-dictid=\"ab375457da16927771891fcf9431da\">impacted</span> fractures</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Walking is not possible due to the instability</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>External <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">Rotation</span> Deformity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less than 45º</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More than 45º</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Shortening</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less than 1 inch</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More than 1 inch</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Supply Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High risk of <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> (medial <span class=\"customMeta\" data-dictid=\"ed0b0613a81692777184dc4b974a19\">circumflex</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disruption)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower risk of <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> necrosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less blood loss due to <span class=\"customMeta\" data-dictid=\"9c6f97404e1692777190f9ed62079f\">intracapsular</span> location</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More blood loss due to the involvement of surrounding <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> structures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pain, Severity, and Tenderness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild to moderate pain <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> to the groin/hip region. <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">Tenderness</span> is typically felt in Scarpa’s triangle.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe pain, more generalized around the hip with marked <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> over the greater trochanter. Weight-bearing is difficult or impossible.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment Options</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Non-displaced:</strong> Internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> (e.g., cannulated screws)</li>\n<li><strong>Displaced:</strong> <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> (hemiarthroplasty, total hip replacement)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Almost always requires internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> (e.g., dynamic hip screws, <span class=\"customMeta\" data-dictid=\"5b22285eec169277719026820db11c\">intramedullary</span> nails)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High risk of <span class=\"customMeta\" data-dictid=\"52a1dd8c4f1692777193dd58a0d51c\">nonunion</span> and <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> necrosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Malunion is more common than nonunion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/2gH7Az1ooDj6C1hDzxM91738308198.png\" width=\"4167\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/KhKgT1Asu5U2rngTCwDN1738308247.png\" width=\"4167\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/u5DD0NeafdiRMu0piF5t1743239875.mp3", "video": ""}, {"text": "An elderly patient sustained a fall and was diagnosed with a femoral neck fracture. Upon examination, what is the most likely attitude of the affected limb?", "options": [{"label": "A", "text": "Internally rotated with limb lengthening", "correct": false}, {"label": "B", "text": "Externally rotated with limb shortening", "correct": true}, {"label": "C", "text": "Internally rotated with limb shortening", "correct": false}, {"label": "D", "text": "Externally rotated with limb lengthening", "correct": false}], "correct_answer": "B. Externally rotated with limb shortening", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/4pul52BlyuNacLVjzbG71738308087.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:617px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Low-Energy Trauma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common in elderly with <strong>osteoporosis</strong>; simple fall from <span class=\"customMeta\" data-dictid=\"f428f17ce1169277719924aafd0e51\">standing height</span> can cause a fracture.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Osteoporosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Age-related bone loss; post-menopausal women at higher risk; fractures occur with minimal trauma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathological Fractures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Caused by conditions like metastatic bone disease, multiple myeloma, or Paget’s disease; minimal force needed for fracture.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stress Fractures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Seen in athletes or military personnel due to repetitive stress.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Groin pain radiating to <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> thigh or knee; sharp pain worsened by movement.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inability to Bear Weight</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unable to stand or walk due to pain, less severe in stress fractures.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Attitude of affected limb</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Shortened and externally rotated limb in displaced fractures; limited internal <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> and flexion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bruising and Swelling</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> due to deep <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> neck location; sometimes bruising around hip or groin.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>X-ray (AP and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> views) is the primary modality; fractures are classified using the Garden classification.</p>\n<p><img alt=\"\" data-author=\"Rohan Bhimani \" data-hash=\"\" data-license=\"CC BY-SA \" data-source=\"https://www.wikidoc.org/index.php/File:Xray_Femoral_neck_fracture.gif\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/4pul52BlyuNacLVjzbG71738308087.png\" width=\"2894\"/></p>\n<br/>\n\t\t\t </td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/b2ju4kxVu5FfhtafomsG1743239739.mp3", "video": ""}, {"text": "A 70-year-old woman presents with severe pain in her left hip and is unable to bear weight on the affected leg after slipping and falling at home. An X-ray reveals a fracture of the femoral neck. Using the Garden classification system for femoral neck fractures, what is the likely grade of this fracture?", "options": [{"label": "A", "text": "Grade 1", "correct": false}, {"label": "B", "text": "Grade 2", "correct": false}, {"label": "C", "text": "Grade 3", "correct": true}, {"label": "D", "text": "Grade 4", "correct": false}], "correct_answer": "C. Grade 3", "question_images": ["https://image.prepladder.com/content/E1SagupnJEbA24Mpxguf1738307509.png", "https://image.prepladder.com/content/wnnDgkqRkHGgq38M8s7O1738307473.png"], "explanation_images": ["https://image.prepladder.com/content/jqDXqqu5k6gnzshKJ2PL1738307602.png", "https://image.prepladder.com/content/doKR452NDRocAY0Iivda1738307703.png", "https://image.prepladder.com/content/9i7IKZozXSni8Rp4aKxl1738307908.png", "https://image.prepladder.com/content/PULyLD6KH9tsNaAtDbLZ1738307993.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis/Complications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subcapital</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fracture just below the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most common; high risk of <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> and nonunion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transcervical</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fracture through the midportion of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> neck.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intermediate risk of complications.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Basicervical</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fracture at the base of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> neck.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower risk of <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> but transitions to <span class=\"customMeta\" data-dictid=\"ab0f3917ce1692777187309ec78709\">extracapsular</span> fractures.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:639px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Angle (Pauwels’ Angle)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stability/Prognosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;30°</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most stable, best prognosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30° - 50°</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate stability.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;70°</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Highly unstable, worst <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> with high risk of nonunion.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fracture Details</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Trabecular Alignment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Incomplete, valgus-impacted fracture.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal trabecular alignment.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Best prognosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complete, but without displacement.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal trabecular alignment.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Good <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> with fixation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complete with partial displacement.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Misalignment between head and acetabulum.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased risk of nonunion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complete with full displacement.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trabecular pattern <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> but displaced.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Worst prognosis. High risk of <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> necrosis.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/r5SrJ4vnoITa67BYpSJE1743239627.mp3", "video": ""}, {"text": "An elderly patient with a history of an intracapsular neck of femur fracture presents with hip pain radiating to the groin and thigh, worsening with activity but improving with rest. Examination reveals restricted range of motion and tenderness in the hip. Which of the following arteries is not typically involved in the blood supply to the femoral head, leading to such a presentation?", "options": [{"label": "A", "text": "Foveolar artery", "correct": false}, {"label": "B", "text": "Obturator artery", "correct": false}, {"label": "C", "text": "Inferior gluteal artery", "correct": true}, {"label": "D", "text": "Medial circumflex femoral artery", "correct": false}], "correct_answer": "C. Inferior gluteal artery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/fACbNEICGZaUjk5Y8x9l1738307351.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:704px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Supply Source</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Retinacular Vessels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Major supply, derived from the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"ed0b0613a81692777184dc4b974a19\">circumflex</span> <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> arteries (branches of the deep <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> artery).</li>\n<li>Forms an extensive network along the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> neck.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intraosseous <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">Cervical</span> Vessels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Secondary source, providing additional <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> support through small <span class=\"customMeta\" data-dictid=\"55b31d659b16927771958a15837b10\">penetrating</span> vessels along the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> neck.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Artery of <span class=\"customMeta\" data-dictid=\"c6d5162a2816927771918bfaa5d7ec\">Ligamentum</span> Teres</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tertiary source, also called the foveolar artery.</li>\n<li>Supplies the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head via the <span class=\"customMeta\" data-dictid=\"c6d5162a2816927771918bfaa5d7ec\">ligamentum</span> teres.</li>\n<li>Important in younger patients or in cases of trauma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Obturator Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Provides minor support through its acetabular branch.</li>\n<li>Primarily supplies the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> thigh muscles but contributes to anastomoses around the hip joint.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/XmEZ3UMsti7RFOG9w2B91743234179.mp3", "video": ""}, {"text": "A 25-year-old male was admitted to the ICU after a motorcycle accident with a femur fracture 24 hours ago. He is confused, has a petechial rash, tachycardia (HR 120), tachypnea (RR 28), and an oxygen saturation of 65%. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Fat Embolism", "correct": true}, {"label": "B", "text": "Pulmonary Embolism", "correct": false}, {"label": "C", "text": "Deep Vein Thrombosis", "correct": false}, {"label": "D", "text": "Pneumothorax", "correct": false}], "correct_answer": "A. Fat Embolism", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/xY2yIh6vTGKyoecfSyXf1738307107.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fat Embolism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fat <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> is a multi-organ disorder caused by fat globules entering the bloodstream, commonly occurring after high-risk <span class=\"customMeta\" data-dictid=\"0b8eb98a3f16927771945b310aec42\">orthopedic</span> injuries, particularly <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> fractures.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classic Triad</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hypoxia</li>\n<li>Petechiae</li>\n<li>Altered mental status</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tachycardia, fever, anemia, thrombocytopenia, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> (e.g., tachypnea, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> acidosis).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Young adults</strong> (20-30 years): <strong>Long bone fractures</strong></li>\n<li><strong>Iatrogenic cause: </strong>Occurs after reamed <span class=\"customMeta\" data-dictid=\"5b22285eec169277719026820db11c\">intramedullary</span> (IM) <span class=\"customMeta\" data-dictid=\"cb2d373f701692777193324602b6fa\">nailing</span> of the femur.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Following injury, fat from <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> or <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> <span class=\"customMeta\" data-dictid=\"36e1a07ab01692777180db73f01e84\">agglutination</span> enters injured vessels and travels as emboli, leading to various clinical manifestations.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Chest X-ray: </strong>Snowstorm appearance (pathognomonic).</li>\n</ul>\n<p><img alt=\"\" data-author=\"Arencibia, Yanetsy &amp; Vo, Mai &amp; Kinaga, Jennifer &amp; Uribe, Jorge &amp; Velasquez, Gloria &amp; Madruga, Mario &amp; Carlan, Steve.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/CXR-showed-diffuse-bilateral-infiltrates-in-a-snowstorm-pattern_fig3_329820422\" data-tags=\"\" height=\"776\" src=\"https://image.prepladder.com/content/xY2yIh6vTGKyoecfSyXf1738307107.png\" width=\"872\"/></p>\n<p> </p>\n<ul>\n<li>PaO₂ &lt;60 mm Hg.</li>\n<li>Platelet count &lt;1.5 lakhs.</li>\n<li><strong>ECG: </strong>Prominent S-wave</li>\n<li><strong>Other lab findings: </strong>Anemia, hypocalcemia.</li>\n<li><strong>CT scan and MRI: </strong>Assess severity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Respiratory support: </strong>Oxygen or <span class=\"customMeta\" data-dictid=\"072a58ab7d169277720130e58f9614\">ventilator</span> support to restore PaO₂.</li>\n<li><strong>Drug therapy:</strong>\n<ul>\n<li><strong>Steroids: </strong>Reduce lung <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and improve gas exchange.</li>\n<li><strong>Heparin: </strong>Lipolytic and <span class=\"customMeta\" data-dictid=\"257da9409416927771815e64ee5df1\">antiplatelet</span> agent.</li>\n<li><strong>Low <span class=\"customMeta\" data-dictid=\"b2df2436bf1692777193d90e9c0132\">molecular weight</span> dextran: </strong>Increases <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> volume.</li>\n<li>Antibiotics and other supportive care.</li>\n</ul>\n</li>\n<li><strong>Definitive <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> treatment: </strong>Early <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> to prevent worsening.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/yEQDDHO2VBjKUNxzc5hD1743233407.mp3", "video": ""}, {"text": "A 35-year-old male presents after a high-speed motor vehicle accident. He is hypotensive with a blood pressure of 70/40 mmHg, has a perineal hematoma, and blood at the urethral meatus. Which of the following statements is correct regarding the management of this patient?", "options": [{"label": "A", "text": "External fixation should be performed once the patient is stable.", "correct": false}, {"label": "B", "text": "Intraperitoneal bladder injuries are treated nonoperatively.", "correct": false}, {"label": "C", "text": "REBOA should be performed immediately to control hemorrhage.", "correct": true}, {"label": "D", "text": "Micturating cysto-urethrogram done immediately to evaluate for urethral injury.", "correct": false}], "correct_answer": "C. REBOA should be performed immediately to control hemorrhage.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/OXRlxMY6EjalMt9O7VLw1738307029.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/NgOnvnfhV2TAUaLd8i5t1743233292.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 33 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 20</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Lower Limb Traumatology-Spine Pelvis And Lower Limb Traumatology-Ii - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 20</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. 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Physical examination reveals a positive straight-leg raising test at 20 degrees, and sensory loss over the dorsum of the foot. Which is the most appropriate investigation to confirm the diagnosis?", "options": [{"label": "A", "text": "Electromyography (EMG)", "correct": false}, {"label": "B", "text": "Plain X-ray", "correct": false}, {"label": "C", "text": "MRI scan", "correct": true}, {"label": "D", "text": "Myelography", "correct": false}], "correct_answer": "C. MRI scan", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/RIHjsUf2v6X3ramN6Y1k1737782277.png", "https://image.prepladder.com/content/WRVdq4A9jlByJNFvWaO11737782359.png", "https://image.prepladder.com/content/MtBQwzyqRhPPrE3XfPJ31737782412.png", "https://image.prepladder.com/content/qkpGMrvViTiR4Jxo5q141737782446.png", "https://image.prepladder.com/content/9SOxRMhkSyHPHSoSLB2L1737782480.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:586px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Plain <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Useful to rule out bony pathology. In chronic cases, disc space narrowing and vertebral <span class=\"customMeta\" data-dictid=\"3083a6c3961692777191b9a4adef78\">lipping</span> may be seen.</p>\n<p>Three types of osteophytes related to the degenerative spine: <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">Traction</span> osteophytes, <span class=\"customMeta\" data-dictid=\"c2193cdaa816927771843863690961\">Claw</span> osteophytes, Wrap around bumper osteophytes.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Sarindam7 \" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:L5S1_prolapsed_intervertibral_disc_PID.jpg\" data-tags=\"\" height=\"550\" src=\"https://image.prepladder.com/content/RIHjsUf2v6X3ramN6Y1k1737782277.png\" width=\"745\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Myelography </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Useful when CT or <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> is unavailable. Shows <span class=\"customMeta\" data-dictid=\"e8a3764ab516927771863f3212fc41\">dye</span> flow block, indentation, or root cut-off sign in <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> prolapse.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Tanya Kitova\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Lumbo-dorsal-myelography-demonstrating-multilevel-lumbar-stenosis-and-severe-compressions_fig1_271849249\" data-tags=\"\" height=\"369\" src=\"https://image.prepladder.com/content/WRVdq4A9jlByJNFvWaO11737782359.png\" width=\"458\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CT Scan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reveals disc shape abnormalities, loss of pre-thecal fat, and <span class=\"customMeta\" data-dictid=\"18b73c28601692777188f2aae28838\">herniated</span> material pressing on <span class=\"customMeta\" data-dictid=\"64d06f977116927771936e3af9572f\">nerve roots</span> or theca.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Ali Abou-Madawi\" data-hash=\"\" data-license=\"CC BY\" data-source=\"https://www.researchgate.net/figure/A-CT-scan-image-showing-L5-S1-disc-prolapse-with-avulsion-of-the-epiphysis_fig2_319893187\" data-tags=\"\" height=\"283\" src=\"https://image.prepladder.com/content/MtBQwzyqRhPPrE3XfPJ31737782412.png\" width=\"314\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MRI Scan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gold standard. Clearly shows the prolapsed disc, nerve roots, and thecal sac.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Miguel Tremblay\" data-hash=\"\" data-license=\"CC0\" data-source=\"https://en.wikipedia.org/wiki/Spinal_disc_herniation\" data-tags=\"\" height=\"1059\" src=\"https://image.prepladder.com/content/qkpGMrvViTiR4Jxo5q141737782446.png\" width=\"699\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Electromyography (EMG) </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rarely required, but can localize nerve root denervation, especially in multiple disc <span class=\"customMeta\" data-dictid=\"c49cc1bac4169277719692da7af2cc\">prolapse</span> cases.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:586px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rest</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bed rest on a hard surface for 2-4 days.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Analgesics and muscle relaxants for pain and muscle <span class=\"customMeta\" data-dictid=\"0338b655da16927771984b872baabb\">spasm</span> relief.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Physiotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hot fomentation, gentle exercises, <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> traction, and TENS.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Indicated for <span class=\"customMeta\" data-dictid=\"657533bf1d16927771839f7875a8eb\">cauda</span> equina syndrome or failed conservative treatment.</p>\n<p><strong>Fenestration</strong>: Removal of the <span class=\"customMeta\" data-dictid=\"c6d5162a2816927771918bfaa5d7ec\">ligamentum</span> flavum to expose the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> canal.</p>\n<p><strong>Laminotomy</strong>: Creation of a small opening in the <span class=\"customMeta\" data-dictid=\"9864ad42b21692777191febeee1002\">lamina</span> for greater exposure.</p>\n<p><strong>Hemi-laminectomy</strong>: Removal of the entire <span class=\"customMeta\" data-dictid=\"9864ad42b21692777191febeee1002\">lamina</span> on one side.</p>\n<p><strong>Laminectomy</strong>: Removal of <span class=\"customMeta\" data-dictid=\"2c3dc02043169277719144ed88d0d2\">laminae</span> on both sides along with the <span class=\"customMeta\" data-dictid=\"6ecc9fc8e416927771993c575ccc1e\">spinous</span> process, often required for large central discs causing <span class=\"customMeta\" data-dictid=\"657533bf1d16927771839f7875a8eb\">cauda</span> equina syndrome.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chemonucleolysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enzyme <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> (chymopapain) into the disc to dissolve <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> tissue.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Percutaneous Discectomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> removal of the disc via <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> instruments or laser probes.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/gLDHH6Nwoc4HQyc0zmi61743246212.mp3", "video": ""}, {"text": "An 18-year-old girl comes to the orthopedics department with complaints of deformity of her back. On physical and radiological examination she has moderate curvature of the spine with a Cobb’s angle of 30 degrees. Which of the following is not an indication of surgery for scoliosis?", "options": [{"label": "A", "text": "Congenital scoliosis that rapidly progresses", "correct": false}, {"label": "B", "text": "Curves deteriorating on radiography", "correct": false}, {"label": "C", "text": "Postural curvature less than 30°", "correct": true}, {"label": "D", "text": "Scoliosis associated with back pain", "correct": false}], "correct_answer": "C. Postural curvature less than 30°", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Blb6KRcsU42Mlb8LkNSE1738300899.png", "https://image.prepladder.com/content/nUszViUDTPFG2wVbaN5C1738300945.png", "https://image.prepladder.com/content/rwfd4l7Kt34IJuaO4KLO1738300963.png", "https://image.prepladder.com/content/WgbBtKxvwDtNjQSzfMbE1738301170.png", "https://image.prepladder.com/content/WKFWBbn2oXRSaGshfXnu1738301238.png", "https://image.prepladder.com/content/JXvVOXtIB35aA5UcZUrQ1738301266.png", "https://image.prepladder.com/content/6ZjGkbYPvOU8Jt9IBZUh1738301302.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:384px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cobb’s angle (degree)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severity </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0-10</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spinal curve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10-20</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild scoliosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20-40</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate scoliosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;40</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe scoliosis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8TZALyy6c1wc7xRNy95o1743247390.mp3", "video": ""}, {"text": "A 30-year-old avid runner complains of a tender lump on the dorsum of his foot, just distal to the midshaft of the first metatarsal. He mentions that the pain started gradually after increasing his running distance. An X-ray image is given below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Jones fracture", "correct": false}, {"label": "B", "text": "March fracture", "correct": true}, {"label": "C", "text": "Lisfranc injury", "correct": false}, {"label": "D", "text": "Turf toe", "correct": false}], "correct_answer": "B. March fracture", "question_images": ["https://image.prepladder.com/content/F0M7wt1I2O83dNB5vX6g1738305510.png"], "explanation_images": ["https://image.prepladder.com/content/bY0XowxF3J6bfT5Kc7qS1738305571.png", "https://image.prepladder.com/content/KLm2RaMqapRFAtxdGFii1738305623.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/HkA62ysA7nSUt4SJM1LV1743315631.mp3", "video": ""}, {"text": "A 22-year-old female dancer presents with pain and swelling in her right foot after landing awkwardly on the side of her foot while performing a dance move. She reports hearing a \"pop\" at the time of injury. Which of the following fractures is commonly seen in this scenario?", "options": [{"label": "A", "text": "Avulsion of the tuberosity of 5th metatarsal", "correct": false}, {"label": "B", "text": "Metaphyseal-diaphyseal junction fracture of 5th metatarsal", "correct": false}, {"label": "C", "text": "Spiral fracture of distal 5th metatarsal", "correct": true}, {"label": "D", "text": "Diaphyseal stress fracture", "correct": false}], "correct_answer": "C. Spiral fracture of distal 5th metatarsal", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/x3Rsuqpj7D3OSg7GW4sc1738305168.png", "https://image.prepladder.com/content/69YhN60RJdUeX7HgfAS21738305210.png", "https://image.prepladder.com/content/y9GQiNT2JPzpZEOxHneG1738305270.png", "https://image.prepladder.com/content/5UjVD3gw5poY5htKdbvM1738305386.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:600px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Zone 1 </strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hindfoot <span class=\"customMeta\" data-dictid=\"94fdb58dbf16927771904508108f50\">inversion</span> during plantarflexion (e.g., awkward landing)</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proximal to the 4th/5th <span class=\"customMeta\" data-dictid=\"557a93441a169277719087fa26089c\">intermetatarsal</span> joints</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rarely involves the fifth <span class=\"customMeta\" data-dictid=\"a3b012f5661692777200bc29594c41\">tarsometatarsal</span> joint; less severe</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pseudo-Jones</strong> <strong>Fracture</strong> (Tuberosity Avulsion) <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Zone 2 </strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Significant <span class=\"customMeta\" data-dictid=\"9efe7f9e921692777180ed75f4948a\">adduction</span> force to the foot with a lifted heel (e.g., sudden direction change)</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4th/5th <span class=\"customMeta\" data-dictid=\"b7f1b05b6d1692777192a18bc2396f\">metatarsal</span> articulation</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15-30% <span class=\"customMeta\" data-dictid=\"52a1dd8c4f1692777193dd58a0d51c\">nonunion</span> rate; higher risk of complications</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Jones <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> </strong>(Metaphyseal-Diaphyseal Junction) <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Zone 3</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic repetitive <span class=\"customMeta\" data-dictid=\"c4a228d455169277719232161686e9\">microtrauma</span> causing gradual onset of pain</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diaphysis of the 5th metatarsal</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High risk of nonunion; increasing pain with activity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diaphyseal Stress</strong> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> <strong>(Option D)</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fracture Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conservative Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Zone 1 (Pseudo-Jones fractures)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Protected weight-bearing with a hard-soled shoe or cast for 3-6 weeks.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Surgery if &gt;30% of the <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> surface is involved or &gt;2 mm <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> step-off (open reduction and internal fixation).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Zone 2</strong></p>\n<p><strong>(Jones fractures)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Non-weight <span class=\"customMeta\" data-dictid=\"2bb6ddacfd169277718230a816b21f\">bearing</span> in a short leg cast for 6-8 weeks.</li>\n<li>Gradual weight-bearing as <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> progresses.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Surgery for high-performance athletes, patients opting for surgery, or displaced fractures (intramedullary screw or tension band fixation).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Zone 3 </strong></p>\n<p><strong>(Stress fractures)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Non-weight <span class=\"customMeta\" data-dictid=\"2bb6ddacfd169277718230a816b21f\">bearing</span> in a short leg cast, possibly up to 20 weeks.</li>\n<li>Nonunion is common.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Surgery may involve <span class=\"customMeta\" data-dictid=\"5b22285eec169277719026820db11c\">intramedullary</span> screw <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> or bone grafting, especially for high-performance athletes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dancer’s Fractures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Weight-bearing as tolerated, same as Zone 1 treatment for nondisplaced fractures.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Surgery for delayed union, nonunion, &gt;3 mm displacement, or &gt;10 degrees angulation.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/FxXZyQBx3b5dHxG5MgJp1743315465.mp3", "video": ""}, {"text": "A 20-year-old man suffered from an injury to his foot and has swelling and pain at the site. The X-ray image shows as follows: Which of the following statements is true about the diagnosis?", "options": [{"label": "A", "text": "The Lisfranc joint is formed by the metatarsals and phalanges", "correct": false}, {"label": "B", "text": "Dislocations are common and can be caused by low-energy trauma", "correct": false}, {"label": "C", "text": "A subluxation or dislocation requires 4–6 weeks of cast or boot immobilization A lateral view X-ray shows dorsal displacement of the second metatarsal base", "correct": false}, {"label": "D", "text": "A lateral view X-ray shows dorsal displacement of the second metatarsal base", "correct": true}], "correct_answer": "D. A lateral view X-ray shows dorsal displacement of the second metatarsal base", "question_images": ["https://image.prepladder.com/content/jT6s0qnQUSeA9HXqUr8g1738304958.png"], "explanation_images": ["https://image.prepladder.com/content/wV2kn6Sz6ETQd6oUiTOP1738305028.png", "https://image.prepladder.com/content/s6HnKwzIBpFGZ0YS6Hbw1738305070.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/z0ONJVx33B62BfnYla8F1745754273.mp3", "video": ""}, {"text": "A 35-year-old man presents with severe heel pain following a fall from a ladder. X-rays indicate a comminuted fracture of the calcaneus. Based on the expected changes in angles associated with this type of injury, which of the following is most likely?", "options": [{"label": "A", "text": "Reduced Bohler and increased Gissane angle", "correct": true}, {"label": "B", "text": "Increased Bohler and reduced Gissane", "correct": false}, {"label": "C", "text": "Both Bohler and Gissane angles reduced", "correct": false}, {"label": "D", "text": "Both Bohler and Gissane angles increased", "correct": false}], "correct_answer": "A. Reduced Bohler and increased Gissane angle", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/N7EOXcwDXPb5moQ1YfWn1738304509.png", "https://image.prepladder.com/content/njuTV05LbqN9h70ifEWm1738304873.png", "https://image.prepladder.com/content/iwqt9WREeXacTdD8yrdm1738304699.png", "https://image.prepladder.com/content/fBIYxfIlGW1HGLyXjm3i1738304779.png", "https://image.prepladder.com/content/HkRq2eUap8yaufqyTcZI1738304578.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/uQKJpfLv6tZWGu0gLge71743315152.mp3", "video": ""}, {"text": "A 25-year-old patient presents to the emergency department after a road traffic accident. He reports severe ankle pain and is unable to bear weight. X-rays reveal a fracture in the neck of the talus, and is shown below. Based on Hawkin's classification, which type of fracture does this represent?", "options": [{"label": "A", "text": "Type I", "correct": false}, {"label": "B", "text": "Type II", "correct": false}, {"label": "C", "text": "Type III", "correct": true}, {"label": "D", "text": "Type IV", "correct": false}], "correct_answer": "C. Type III", "question_images": ["https://image.prepladder.com/content/iNI3LECaubeFk4rlMxNp1738303570.png"], "explanation_images": ["https://image.prepladder.com/content/Alpj3PGS90jDLeOIkGon1738304035.png", "https://image.prepladder.com/content/T7JtNQweSQKGnQbMfNa61738304083.png", "https://image.prepladder.com/content/n3JqoYgyGBTvlo1iIzkO1738304150.png", "https://image.prepladder.com/content/xiMGuDnG7xRHqIz4rMUf1738304301.png", "https://image.prepladder.com/content/X2KXjJOSHIEctxflLysR1738304370.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type I</strong><strong> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Undisplaced vertical <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> neck of talus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type II</strong><strong> (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Displaced <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> neck + <span class=\"customMeta\" data-dictid=\"e53b153fb316927771996481a3e88f\">Subluxation</span> or <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of <span class=\"customMeta\" data-dictid=\"1d205eb28916927771997a96a2124f\">subtalar</span> joint</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type III</strong><strong> (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Displaced <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> neck + <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">Dislocation</span> of the body of the <span class=\"customMeta\" data-dictid=\"ee55b45c5f1692777200dd3dd0256a\">talus</span> from both ankle and <span class=\"customMeta\" data-dictid=\"1d205eb28916927771997a96a2124f\">subtalar</span> joints</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type IV</strong><strong> (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Displaced <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> neck + <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">Dislocation</span> of the head and body of the <span class=\"customMeta\" data-dictid=\"ee55b45c5f1692777200dd3dd0256a\">talus</span> from subtalar/ankle/talonavicular joints</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Undisplaced Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Displaced Fracture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Conservative treatment</li>\n<li>Below-knee <span class=\"customMeta\" data-dictid=\"6c22f2390016927771955c0c04b851\">plaster</span> cast</li>\n<li>For 8-10 weeks</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Closed reduction by <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> in <span class=\"customMeta\" data-dictid=\"a7a430f3a9169277719510c13f434d\">plantar</span> <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> and a <span class=\"customMeta\" data-dictid=\"6c22f2390016927771955c0c04b851\">plaster</span> cast is put in equinus.</li>\n<li>If it fails, ORIF with <span class=\"customMeta\" data-dictid=\"6ef2a80e2116927771915098fa1789\">lag</span> screws is done.</li>\n<li>Sometimes <strong>Herbert bone screw</strong> is used:\n\t\t\t\t<ul>\n<li>Headless <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> screw</li>\n<li>Generally not removed</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/AITriWovJFiRghXw89cT1743315045.mp3", "video": ""}, {"text": "A 45-year-old man presents to the emergency department after falling from a ladder. He has tenderness over the heel and lower back pain. X-ray foot is taken and is shown below. What type of fracture might he have, especially given the association with lumbar spine injuries?", "options": [{"label": "A", "text": "Lover’s Fracture", "correct": true}, {"label": "B", "text": "Chopart’s Fracture", "correct": false}, {"label": "C", "text": "Tibial Pilon Fracture", "correct": false}, {"label": "D", "text": "Maisonneuve Fracture", "correct": false}], "correct_answer": "A. Lover’s Fracture", "question_images": ["https://image.prepladder.com/content/rUWMKzkUuKi57rixZ3Vh1738303027.png"], "explanation_images": ["https://image.prepladder.com/content/E29AksYTnc5ly18z7d2i1738303033.png", "https://image.prepladder.com/content/CxqZjEVQ6Sipye936f8U1738303197.png", "https://image.prepladder.com/content/qEysTQR8qwT9EbP2meYM1738303239.png", "https://image.prepladder.com/content/rZbmDmsVlyGo7K8WBWJE1738303300.png", "https://image.prepladder.com/content/S6YyE6dRYwRJHtkPgmk21738303387.png", "https://image.prepladder.com/content/iSq7hC6FXPJxCSmsOOoh1738303437.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/kKes0eS2Qhg5ft6bIOxJ1743314911.mp3", "video": ""}, {"text": "A 35-year-old female presents to the clinic after twisting her ankle while stepping off a curb. She experiences significant pain and swelling around her ankle. X-ray AP view of the ankle joint is shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Cotton Fracture", "correct": true}, {"label": "B", "text": "Pott's Fracture", "correct": false}, {"label": "C", "text": "Lisfranc Fracture", "correct": false}, {"label": "D", "text": "Chopart Fracture", "correct": false}], "correct_answer": "A. Cotton Fracture", "question_images": ["https://image.prepladder.com/content/liKhrMV3anFsiwMM6eRg1738302466.png"], "explanation_images": ["https://image.prepladder.com/content/vmzzKAnVaGHLOtMtz2B91738302516.png", "https://image.prepladder.com/content/wBdAcckRtoBzlIIggvxY1738302542.png", "https://image.prepladder.com/content/3uhHHGoIB8GsRRKvM6cM1738302582.png", "https://image.prepladder.com/content/NESPuED5T3rJmWtwugpD1738302662.png", "https://image.prepladder.com/content/xDUICuVXi0x4qT5F5yDV1738302747.png", "https://image.prepladder.com/content/w5dhf5e1Kr4D3KsbIcYD1738302705.png", "https://image.prepladder.com/content/jpMbn4IyTzOGp35VadHQ1738302888.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:741px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pott’s Fracture</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cotton Fracture</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bony injuries and fractures around the <span class=\"customMeta\" data-dictid=\"27b1d5d7f916927771821f94581a42\">ankle joint</span> are colloquially known as Pott's fractures.</li>\n<li>Bimalleolar fracture, it involves <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> malleolus.</li>\n<li>Percival Pott (1768) described a <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of <span class=\"customMeta\" data-dictid=\"9e7e90693316927772027cba1a6018\">fibula</span> 2–3 inches above the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> tip with an associated <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> of the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> ligaments and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"e53b153fb316927771996481a3e88f\">subluxation</span> of <span class=\"customMeta\" data-dictid=\"ee55b45c5f1692777200dd3dd0256a\">talus</span> and therefore bears his name.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Trimalleolar fracture, it involves medial, lateral, and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> malleolus.</li>\n<li>This is a difficult injury complex to treat.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fracture </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/vmzzKAnVaGHLOtMtz2B91738302516.png\" width=\"400\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/wBdAcckRtoBzlIIggvxY1738302542.png\" width=\"400\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of injury:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Supination-Adduction injury</li>\n<li>Pronation-Abduction injury</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Supination-External <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> injury</li>\n<li>Pronation-External <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> injury</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-Ray </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Mohammad Osama Hussein Yonso\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/bimalleolar-ankle-fracture-3#image-63425093\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/3uhHHGoIB8GsRRKvM6cM1738302582.png\" width=\"331\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Chaim Mintz\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Trimalleolar_fracture\" data-tags=\"\" height=\"284\" src=\"https://image.prepladder.com/content/NESPuED5T3rJmWtwugpD1738302662.png\" width=\"400\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li><strong>Fracture without displacement:</strong> Below-knee <span class=\"customMeta\" data-dictid=\"6c22f2390016927771955c0c04b851\">plaster</span> for 3-6 weeks</li>\n<li><strong>Fracture with displacement:</strong></li>\n</ol>\n<ul>\n<li>Open reduction is indicated for failed closed reduction, displaced and unstable fractures.</li>\n<li><strong>Medial <span class=\"customMeta\" data-dictid=\"6a7ff3e34716927771914c22e9fe4e\">Malleolus</span> Fracture:</strong>\n<ul>\n<li>Transverse fracture: <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">Compression</span> screw, tension-band wiring</li>\n<li>Oblique fracture: <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">Compression</span> screws</li>\n<li>Avulsion <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> tension: Band wiring</li>\n</ul>\n</li>\n<li><strong>Lateral <span class=\"customMeta\" data-dictid=\"6a7ff3e34716927771914c22e9fe4e\">Malleolus</span> Fracture:</strong>\n<ul>\n<li>Transverse fracture: Tension-band wiring</li>\n<li>Spiral fracture: <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">Compression</span> screws</li>\n<li>Comminuted fracture: Buttress plating</li>\n<li>Fracture of the lower third of fibula-4-hole plate</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Often requires <strong>open reduction and internal fixation.</strong></li>\n<li><strong>Medial <span class=\"customMeta\" data-dictid=\"6a7ff3e34716927771914c22e9fe4e\">Malleolus</span> Fracture:</strong>\n<ul>\n<li>Transverse fracture: <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">Compression</span> screw, tension-band wiring</li>\n<li>Oblique fracture: <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">Compression</span> screws</li>\n<li>Avulsion <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> tension: Band wiring</li>\n</ul>\n</li>\n<li><strong>Lateral <span class=\"customMeta\" data-dictid=\"6a7ff3e34716927771914c22e9fe4e\">Malleolus</span> Fracture:</strong>\n<ul>\n<li>Transverse fracture: Tension-band wiring</li>\n<li>Spiral fracture: <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">Compression</span> screws</li>\n<li>Comminuted fracture: Buttress plating</li>\n<li>Fracture of the lower third of fibula-4-hole plate</li>\n</ul>\n</li>\n<li><strong>Posterior <span class=\"customMeta\" data-dictid=\"6a7ff3e34716927771914c22e9fe4e\">Malleolus</span> Fracture:</strong>\n<ul>\n<li>Involving &lt;⅓ of the articulating surface of the tibia: No additional treatment</li>\n<li>Involving &gt;⅓ of the articulating surface of the tibia: Internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> with <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> screws</li>\n<li>Tibio-fibular <span class=\"customMeta\" data-dictid=\"3e76634cff169277719913c5f4bf9e\">syndesmosis</span> disruption: Needs to be stabilized by inserting a long screw from the <span class=\"customMeta\" data-dictid=\"9e7e90693316927772027cba1a6018\">fibula</span> into the tibia</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>After Surgery X-Ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Mohammad Osama Hussein Yonso\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/bimalleolar-ankle-fracture-3#image-63425093\" data-tags=\"\" height=\"397\" src=\"https://image.prepladder.com/content/xDUICuVXi0x4qT5F5yDV1738302747.png\" width=\"400\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Chaim Mintz\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Trimalleolar_fracture\" data-tags=\"\" height=\"284\" src=\"https://image.prepladder.com/content/w5dhf5e1Kr4D3KsbIcYD1738302705.png\" width=\"400\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/6hHmmYaxa9s9q9PwlxOh1743319024.mp3", "video": ""}, {"text": "A 45-year-old male sustained a high-energy impact injury to his left leg in a motor vehicle accident. He presents with knee pain, swelling, and difficulty bearing weight. X-ray reveals a displaced lateral tibial condyle fracture. What is the most appropriate initial management?", "options": [{"label": "A", "text": "Non-weight bearing with a knee brace", "correct": false}, {"label": "B", "text": "Immediate open reduction and internal fixation (ORIF)", "correct": true}, {"label": "C", "text": "Closed reduction and casting", "correct": false}, {"label": "D", "text": "Arthroscopic repair of meniscal tear", "correct": false}], "correct_answer": "B. Immediate open reduction and internal fixation (ORIF)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/tqHpul7ebM4iEoWA4sjm1738302370.png", "https://image.prepladder.com/content/jlX0cEtb0iXEQoWdJPrR1738302410.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:630px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Compartment syndrome:</strong> Can occur due to increased pressure in the leg compartments, requiring emergency treatment.</li>\n<li><strong>Popliteal <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> injury: </strong>Risk due to proximity of the <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> <span class=\"customMeta\" data-dictid=\"7a4ced7da71692777195938424f299\">plateau</span> to <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> structures.</li>\n<li><strong>Peroneal nerve injury:</strong> May result in <span class=\"customMeta\" data-dictid=\"82bdbd3b8616927772024e0c20a19a\">foot drop</span> due to nerve damage.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Non-surgical: </strong>Stable fractures, minimal <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> (elderly).</li>\n</ul>\n<img alt=\"\" data-author=\"Jonuscumgi\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Long_leg_cast.jpg\" data-tags=\"\" height=\"650\" src=\"https://image.prepladder.com/content/tqHpul7ebM4iEoWA4sjm1738302370.png\" width=\"425\"/>\n<ul>\n<li><strong>Surgical (ORIF): </strong>Displaced fractures, significant depression, or bicondylar involvement (young adults).</li>\n</ul>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/jlX0cEtb0iXEQoWdJPrR1738302410.png\" width=\"4167\"/> \n\t\t\t<ul>\n<li>Ligament <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> if needed.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/x65N4Z0dCi6xi3tiG7B41743247650.mp3", "video": ""}, {"text": "A 45-year-old pedestrian after being hit by a car while crossing the street. The car's bumper struck his leg from the side, impacting the knee area. On examination, there is swelling, bruising, and a noticeable valgus deformity of the knee. The patient complains of difficulty walking and inability to bear weight. What is the most likely fracture sustained by the patient?", "options": [{"label": "A", "text": "Medial tibial condyle fracture", "correct": false}, {"label": "B", "text": "Lateral tibial condyle fracture", "correct": true}, {"label": "C", "text": "Fibular head fracture", "correct": false}, {"label": "D", "text": "Patellar fracture", "correct": false}], "correct_answer": "B. Lateral tibial condyle fracture", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zwIZflaM2nl3ZmiWS7yV1738302240.png", "https://image.prepladder.com/content/1QkcdLy2fASDeLC9j8XH1738302262.png", "https://image.prepladder.com/content/gYifsTxj4XabQK7OBpxv1738302289.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:643px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> <span class=\"customMeta\" data-dictid=\"7a4ced7da71692777195938424f299\">plateau</span> refers to the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> surface, which comprises the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> surfaces of the respective <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> condyles.</p>\n<p><strong>Lateral <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> <span class=\"customMeta\" data-dictid=\"7a4ced7da71692777195938424f299\">plateau</span> fractures are the most common.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The main mechanism of injury is a <span class=\"customMeta\" data-dictid=\"5cdf29eaf516927772012b4a16cde1\">varus</span> or <span class=\"customMeta\" data-dictid=\"e33d939e82169277720167f59b0ee2\">valgus</span> force, with or without <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> load.</li>\n<li>Young Adults: Road traffic accidents, leading to <strong>split fractures</strong> (high <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> injury risk).</li>\n</ul>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"1000\" src=\"https://image.prepladder.com/content/zwIZflaM2nl3ZmiWS7yV1738302240.png\" width=\"1000\"/>\n<ul>\n<li>Elderly: Trivial falls, causing depression or <strong>split depression fractures</strong> (associated with osteoporosis) (low <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> injury risk).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classification (Schatzker)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type I:</strong> <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> <span class=\"customMeta\" data-dictid=\"7a4ced7da71692777195938424f299\">plateau</span> split <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> (young adults).</p>\n<p><strong>Type II:</strong> <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> <span class=\"customMeta\" data-dictid=\"7a4ced7da71692777195938424f299\">plateau</span> split depression (young adults).</p>\n<p><strong>Type III:</strong> <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> <span class=\"customMeta\" data-dictid=\"7a4ced7da71692777195938424f299\">plateau</span> pure depression (elderly).</p>\n<p><strong>Type IV: </strong>Medial <span class=\"customMeta\" data-dictid=\"7a4ced7da71692777195938424f299\">plateau</span> fracture.</p>\n<p><strong>Type V: </strong>Bicondylar fracture.</p>\n<p><strong>Type VI: </strong>Dissociation of <span class=\"customMeta\" data-dictid=\"8ccb80bd4d169277719296d80e2193\">metaphysis</span> and diaphysis.</p>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/1QkcdLy2fASDeLC9j8XH1738302262.png\" width=\"4167\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Knee <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> due to hemarthrosis.</li>\n<li>Inability to bear weight</li>\n<li>Reduce range of knee movements</li>\n<li>Compartment syndrome (earliest sign: <strong>stretch pain</strong>).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>X-ray:</strong> Initial <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> detection.</li>\n</ul>\n<img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:TibPlatFracPlainMark.png\" data-tags=\"\" height=\"310\" src=\"https://image.prepladder.com/content/gYifsTxj4XabQK7OBpxv1738302289.png\" width=\"681\"/>\n<ul>\n<li><strong>CT with 3D Reconstruction:</strong> Gold standard.</li>\n<li><strong>MRI:</strong> To assess <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> injuries.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-surgical: Stable fractures with minimal displacement.</p>\n<p>Surgical (ORIF): For displaced fractures or significant depression.</p>\n<p>Ligament <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> if needed.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/QycE33tSCOzRYUuTyqxT1743247496.mp3", "video": ""}, {"text": "Which of the following statements best describes the function of the structure marked “B” in the below image?", "options": [{"label": "A", "text": "Anchors the intervertebral disc to adjacent vertebrae.", "correct": false}, {"label": "B", "text": "Distributes hydraulic pressure across the disc and absorbs shock.", "correct": true}, {"label": "C", "text": "Helps in providing nutrition to the surrounding annulus fibrosus.", "correct": false}, {"label": "D", "text": "Primarily resists torsion and extension forces on the spine", "correct": false}], "correct_answer": "B. Distributes hydraulic pressure across the disc and absorbs shock.", "question_images": ["https://image.prepladder.com/content/yxStzH1TgmlvD7NWXBUL1737779530.png"], "explanation_images": ["https://image.prepladder.com/content/OvvsfJGkkyRdc5jzlRy11737779571.png", "https://image.prepladder.com/content/NbKjGdfBBQVQmdNwcNOL1737779597.png", "https://image.prepladder.com/content/8C6Kf4LNPs2oxJLbcQ1V1736217060.png", "https://image.prepladder.com/content/kVzFmvw1j4qwf6n1hK0P1737779634.png", "https://image.prepladder.com/content/RlkxpHZWPRYd2AMjSYhx1737779664.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Component</strong></h3>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Description</strong></h3>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Function</strong></h3>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Nucleus Pulposus</strong></h3>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gel-like center with high water content, collagen, and proteoglycans</p>\n<p>Mostly consists of <strong>Type II collagen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distributes pressure, provides flexibility and shock absorption</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Annulus Fibrosus</strong></h3>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Consists of 15 to 25 <span class=\"customMeta\" data-dictid=\"9bb62139a81692777184648bfef564\">concentric</span> lamellae, of predominantly collagen, with interspersed proteoglycans, glycoproteins and <span class=\"customMeta\" data-dictid=\"2dba7c03f61692777187254f866bcc\">elastic</span> fibers</p>\n<p>Mostly consists of <strong>Type I collagen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Encases <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">Nucleus</span> pulposus, provides strength, and resists <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> and <span class=\"customMeta\" data-dictid=\"49c306e91e1692777200be46fecf66\">torsion</span> <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Cartilaginous Endplates</strong></h3>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thin layers connecting discs to vertebrae</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maintains disc stability, allows <span class=\"customMeta\" data-dictid=\"9c760dcb641692777186f4cda5dc95\">diffusion</span> of nutrients, <span class=\"customMeta\" data-dictid=\"517e55e7781692777181b4d509dbdd\">anchor</span> the discs to adjacent <span class=\"customMeta\" data-dictid=\"9c0b99fa0816927772010e947b4ef6\">vertebrae</span> <strong>(Option A)</strong></p>\n</td>\n</tr>\n</tbody>\n\n<p><strong>References:</strong></p>\n<ul><li>↳ Apley and Solomon’s System of Orthopaedics and Trauma, 10th Edition - Page No. 528-530</li><li>↳ https://www.ncbi.nlm.nih.gov/books/NBK470583/</li><li>↳ Intervertebral disc | Radiology Reference Article | Radiopaedia.org</li><li>↳ https://clinicalgate.com/intervertebral-disc-process-of-degeneration-physiology-and-pathophysiology/</li></u\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/0XBYITVfelvyqOJ5w8fg1743243849.mp3", "video": ""}, {"text": "Which of the following is false about the types of scoliosis?", "options": [{"label": "A", "text": "Idiopathic scoliosis is seen most commonly in adolescents", "correct": false}, {"label": "B", "text": "Congenital scoliosis can grow rapidly and cause neurological deficits", "correct": false}, {"label": "C", "text": "Sciatic scoliosis is due to unilateral muscle spasms", "correct": false}, {"label": "D", "text": "The defect in compensatory scoliosis disappears when the patient bends forward", "correct": true}], "correct_answer": "D. The defect in compensatory scoliosis disappears when the patient bends forward", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/U0oOOyplnYkHzoDOSWGp1738145627.png", "https://image.prepladder.com/content/5ZKcEqGuXzsDdusulaUI1738145672.png", "https://image.prepladder.com/content/vcfn7f3eu1ORdTwVgbek1738145703.png", "https://image.prepladder.com/content/X2Lirn4og8zNzwaneg4R1738145748.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-structural (transient)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structural (permanent) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Temporary <span class=\"customMeta\" data-dictid=\"4bd67d54f016927771850c953dadbc\">curvature</span> that can be corrected.<br/>\n\t\t\t\t </li>\n<li><strong>Postural scoliosis:</strong>\n<ul>\n<li>M/c type; Often seen in adolescent girls. <strong> </strong></li>\n<li>Mild leftward <span class=\"customMeta\" data-dictid=\"00ab88c6091692777185ea2685fa40\">convex</span> curve that <strong>straightens when bending forward</strong>.<br/>\n\t\t\t\t\t </li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Compensatory scoliosis:</strong>\n<ul>\n<li><strong>Develops to compensate for <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> tilt</strong> (e.g., due to hip disease or a short leg).</li>\n<li><strong>The curve disappears when the patient sits </strong><strong>o</strong>r when the underlying issue is resolved.<strong> (Option D)</strong><br/>\n\t\t\t\t\t </li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Sciatic scoliosis:</strong>\n<ul>\n<li>Results from <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> muscle spasms, often due to a prolapsed <span class=\"customMeta\" data-dictid=\"95a8e326831692777190c5101eb835\">intervertebral</span> disc. <strong> (Option C ruled out)</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Involves permanent deformity.<br/>\n\t\t\t\t </li>\n<li><strong>Idiopathic scoliosis:</strong>\n<ul>\n<li>M/c structural type, can begin in infancy, childhood, or adolescence.</li>\n<li>M/c in adolescents <strong>(Option A ruled out)</strong></li>\n<li>Infantile <span class=\"customMeta\" data-dictid=\"a3e3b052331692777198750eaae63a\">scoliosis</span> may resolve or progress, while later-onset <span class=\"customMeta\" data-dictid=\"a3e3b052331692777198750eaae63a\">scoliosis</span> can lead to significant deformity, especially in the <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> region.<br/>\n\t\t\t\t\t </li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Congenital scoliosis:</strong>\n<ul>\n<li>Always associated with vertebral anomalies (e.g., hemivertebrae, block vertebrae, unsegmented bars).</li>\n<li>These curves can grow rapidly and may lead to neurological deficits. <strong> (Option B ruled out)</strong><br/>\n\t\t\t\t\t </li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Paralytic scoliosis:</strong>\n<ul>\n<li>Caused by unbalanced <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> of trunk muscles, commonly due to poliomyelitis, cerebral palsy, or <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> dystrophies.<br/>\n\t\t\t\t\t </li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Other pathologies: Conditions like <strong>neurofibromatosis </strong>can cause<strong> structural <span class=\"customMeta\" data-dictid=\"a3e3b052331692777198750eaae63a\">scoliosis</span> with associated kyphosis.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:252px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risser’s classification</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ossification of</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral 25%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral 50%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral 75%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral 100%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>V</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fusion of the ilium</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/XwdzCej9sHyjgMqwb0E51743247277.mp3", "video": ""}, {"text": "What result from the Modified Schober test would be considered positive for the diagnosis of ankylosing spondylitis?", "options": [{"label": "A", "text": "Increase in lumbar flexion of less than 5 cm", "correct": true}, {"label": "B", "text": "Increase in lumbar flexion of 5-7 cm", "correct": false}, {"label": "C", "text": "Increase in lumbar flexion of 7-10 cm", "correct": false}, {"label": "D", "text": "Increase in lumbar flexion of more than 10 cm", "correct": false}], "correct_answer": "A. Increase in lumbar flexion of less than 5 cm", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JCB0IWRXytctp3LmbxkQ1738145589.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Starting Position</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Patient stands erect, <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> shoulder-width apart.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mark 1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mark made at the <span class=\"customMeta\" data-dictid=\"2d710fe8461692777191d18505790c\">lumbosacral</span> <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> (PSIS, approx. at L5).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mark 2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mark made 10 cm above the <span class=\"customMeta\" data-dictid=\"2d710fe8461692777191d18505790c\">lumbosacral</span> junction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mark 3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mark made 5 cm below the <span class=\"customMeta\" data-dictid=\"2d710fe8461692777191d18505790c\">lumbosacral</span> junction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Movement</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Patient <span class=\"customMeta\" data-dictid=\"247e7aa0181692777182e46b52832d\">bends</span> forward (without bending knees).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measurement</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distance between marks is measured in full flexion.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal Result</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increase in distance by at least 5 cm (total distance ≥ 20 cm).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal Result</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less than 5 cm increase in distance, indicating <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> flexibility (e.g., ankylosing spondylitis).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/GU4mH5X5hl7gZuGnRUn61743247109.mp3", "video": ""}, {"text": "A 28-year-old male presents to the clinic with chronic back pain and stiffness, primarily noted during the morning, which tends to improve with physical activity. X-ray imaging reveals characteristic findings given below. On ophthalmologic examination, what is the most likely ocular finding in this patient?", "options": [{"label": "A", "text": "Keratoconjunctivitis", "correct": false}, {"label": "B", "text": "Episcleritis", "correct": false}, {"label": "C", "text": "Anterior uveitis", "correct": true}, {"label": "D", "text": "Retinal detachment", "correct": false}], "correct_answer": "C. Anterior uveitis", "question_images": ["https://image.prepladder.com/content/V1BuOCXLPN7mUgWI5PtQ1738145067.png"], "explanation_images": ["https://image.prepladder.com/content/p6xCp0rBeLG16Za1mZBy1738145148.png", "https://image.prepladder.com/content/6HphcdbCKSl4CJ0sCoIF1738145183.png", "https://image.prepladder.com/content/StTBJwVLcGt2kmUlApIc1738145222.png", "https://image.prepladder.com/content/xfQgtYOFqp5TdjEry6Uw1738145410.png", "https://image.prepladder.com/content/hsIDRHz6doJ8KWBgIjT91738145271.png", "https://image.prepladder.com/content/n3jteCf6cwJfVUvcp6xl1738145474.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:691px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> disease primarily affecting the <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> <span class=\"customMeta\" data-dictid=\"70f596ae8f16927771983211d9e56f\">skeleton</span> (spine and <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joints), leading to pain, stiffness, and <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> fusion<strong> (bamboo spine)</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unknown; genetic (HLA-B27) and environmental factors involved. HLA-B27 is positive in 90% of cases, but not all carriers develop AS.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inflammation at entheses → <span class=\"customMeta\" data-dictid=\"d6ccfc448916927771877d9bde179f\">Erosive</span> changes → New bone formation → Syndesmophytes → <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">Spinal</span> <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> (ankylosis).</p>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/p6xCp0rBeLG16Za1mZBy1738145148.png\" width=\"4167\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Musculoskeletal Symptoms:</strong></p>\n<ul>\n<li>Chronic low back pain (worse after inactivity, better with activity)</li>\n<li>Limited <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> mobility</li>\n<li>Enthesitis (Achilles, <span class=\"customMeta\" data-dictid=\"a7a430f3a9169277719510c13f434d\">plantar</span> fascia)</li>\n<li>Peripheral <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> (hips, shoulders, knees)</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Extra-articular Symptoms:</strong></p>\n<ul>\n<li><strong>Ocular:</strong> <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> <span class=\"customMeta\" data-dictid=\"b07d6fd6ef1692777201015472cd79\">uveitis</span> (pain, redness, photophobia)</li>\n<li><strong>Cardiovascular:</strong> Aortic regurgitation, <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> issues</li>\n<li><strong>Pulmonary: </strong>Apical fibrosis</li>\n<li><strong>Gastrointestinal:</strong> Associated with IBD</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Based on clinical features, <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> studies, and HLA-B27 gene presence. <strong>Modified New York Criteria:</strong></p>\n\t\t\t \n\n\t\t\t<p><strong>Clinical Criteria:</strong></p>\n<ul>\n<li>Low back pain &gt; 3 months (improves with exercise, not with rest)</li>\n<li>Limited <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> spine motion (sagittal/frontal planes)</li>\n<li>Reduced chest expansion (relative to age/sex)</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Radiographic Criteria (X-ray):</strong></p>\n<p>Bilateral <span class=\"customMeta\" data-dictid=\"d17a3a17bc16927771988d9f2533a8\">sacroiliitis</span> (grade 2-4) or <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> <span class=\"customMeta\" data-dictid=\"d17a3a17bc16927771988d9f2533a8\">sacroiliitis</span> (grade 3-4)</p>\n\t\t\t \n\n\t\t\t<p><strong>Radiological Features:</strong></p>\n<ul>\n<li><strong>Blurring/haziness of <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joint</strong></li>\n</ul>\n<img alt=\"\" data-author=\"Hyun Kyu Chang, Eun Hee Cho, Jeong Uk Kim, Hwan Herr\" data-hash=\"\" data-license=\"CC BY NC 3.0\" data-source=\"https://www.researchgate.net/figure/Plain-pelvis-radiograph-shows-the-obliteration-of-joint-space-in-both-sacroiliac-joints_fig3_12601898\" data-tags=\"\" height=\"1605\" src=\"https://image.prepladder.com/content/6HphcdbCKSl4CJ0sCoIF1738145183.png\" width=\"2852\"/> \n\t\t\t<ul>\n<li><strong>Juxta-articular sclerosis</strong></li>\n<li><strong>Vertical/bridging syndesmophytes</strong></li>\n<li><strong>Squaring of vertebrae</strong></li>\n</ul>\n<img alt=\"\" data-author=\"Glitzy_queen00\" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://commons.wikimedia.org/wiki/File:Ankylosing_spondylitis_lumbar_spine.jpg\" data-tags=\"\" height=\"1605\" src=\"https://image.prepladder.com/content/StTBJwVLcGt2kmUlApIc1738145222.png\" width=\"795\"/> \n\t\t\t<ul>\n<li><strong>Bamboo spine</strong></li>\n<li><strong>Trolley track sign</strong></li>\n<li><strong>Dagger sign</strong></li>\n</ul>\n<img alt=\"\" data-author=\"Wael Nemattalla\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/dagger-sign-in-ankylosing-spondylitis\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/xfQgtYOFqp5TdjEry6Uw1738145410.png\" width=\"3077\"/> \n\t\t\t<ul>\n<li><strong>Shiny corner sign/Romanus <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> </strong>(inflammatory lesions at edges of vertebrae)</li>\n</ul>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/shiny-corner-sign-ankylosing-spondylitis\" data-tags=\"\" height=\"1605\" src=\"https://image.prepladder.com/content/hsIDRHz6doJ8KWBgIjT91738145271.png\" width=\"1260\"/> \n\t\t\t<p><strong>MRI:</strong> Early <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> of inflammation</p>\n\t\t\t \n\n\t\t\t<p><strong>Clinical Tests:</strong></p>\n<p><strong>For Sacroiliitis:</strong></p>\n<ul>\n<li>Gaenslen’s test</li>\n<li>Patrick/FABER test</li>\n<li>Figure of 4 test</li>\n<li>Pump handle test</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>For <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">Lumbar</span> Spine:</strong></p>\n<p><strong>Schober/ Modified Schober test</strong></p>\n<br/>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"1000\" src=\"https://image.prepladder.com/content/n3jteCf6cwJfVUvcp6xl1738145474.png\" width=\"1000\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laboratory Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>HLA-B27 positive (90% of cases)</li>\n<li>ESR, CRP: Elevated during active disease, but can be normal</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mechanical low back pain</li>\n<li>Other spondyloarthropathies (e.g., psoriatic arthritis)</li>\n<li>Degenerative disc disease</li>\n<li>Fibromyalgia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Pharmacological:</strong></p>\n<ul>\n<li>Physical therapy (mobility/posture exercises)</li>\n<li>Patient education on disease and exercise importance</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Pharmacological:</strong></p>\n<ul>\n<li>NSAIDs (first-line for pain, stiffness)</li>\n<li>TNF inhibitors (for NSAID-resistant cases)</li>\n<li>IL-17 inhibitors (Secukinumab)</li>\n<li>Sulfasalazine (for <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> arthritis)</li>\n<li>Corticosteroids (short-term <span class=\"customMeta\" data-dictid=\"68e7440bd91692777202d8a14c33e0\">flare</span> control)</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Surgical:</strong></p>\n<ul>\n<li>Hip replacement (for severe hip involvement)</li>\n<li>Spinal surgery (for severe deformities/fractures)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Spinal fractures (minimal trauma)</li>\n<li>Cardiac issues (aortic regurgitation, <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> defects)</li>\n<li>Osteoporosis leading to <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> risk</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:510px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conditions mimicking <span class=\"customMeta\" data-dictid=\"aabbc63449169277718277060e8642\">Ankylosing Spondylitis</span> with <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> fusion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diffuse <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">Idiopathic</span> Skeletal <span class=\"customMeta\" data-dictid=\"8c947f8b081692777189e13a744a05\">Hyperostosis</span> (DISH) (Forestier’s disease)</li>\n<li>Ossification of <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> <span class=\"customMeta\" data-dictid=\"7ba18aa5e616927771918a45051a40\">Longitudinal</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">Ligament</span> (OPLL)</li>\n<li>Spondylosis (Degenerative Disc Disease)</li>\n<li>Psoriatic Arthritis</li>\n<li>Enteropathic <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">Arthritis</span> (IBD-associated)</li>\n<li>Reactive Arthritis</li>\n<li>Rheumatoid <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">Arthritis</span> (RA)</li>\n<li>Juvenile <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">Idiopathic</span> <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">Arthritis</span> (JIA)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/uj2QI955U87t3AB2Db211743246980.mp3", "video": ""}, {"text": "A 55-year-old woman comes to the orthopedics department with complaints of lower back pain, heaviness, numbness, and paraesthesia in her thighs and legs which are relieved by sitting and squatting. She is diagnosed with lumbar canal stenosis. Which of the following is not a true statement about this condition?", "options": [{"label": "A", "text": "Congenital causes like achondroplasia can lead to lumbar canal stenosis", "correct": false}, {"label": "B", "text": "Central stenosis involves the area between facet joints carrying dural sac and nerve roots", "correct": false}, {"label": "C", "text": "This condition commonly affects women and degeneration is the most common cause", "correct": false}, {"label": "D", "text": "Undercutting facetectomies and ligamentum flavum removal is done for central stenosis", "correct": true}], "correct_answer": "D. Undercutting facetectomies and ligamentum flavum removal is done for central stenosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ip5yR1MzTecIu8MAGted1738144625.png", "https://image.prepladder.com/content/PAR8JuFeosAbubcOQ3Hl1738144762.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:764px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lumbar <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">Canal</span> Stenosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Congenital: Vertebral <span class=\"customMeta\" data-dictid=\"984733db481692777186757cce6e6b\">dysplasia</span> (e.g., achondroplasia, hypochondroplasia). <strong>(Option A)</strong></li>\n<li>Acquired:\n\t\t\t\t<ul>\n<li>Degeneration (most common) <strong>(Option C)</strong></li>\n<li>Spondylolysis</li>\n<li>Spondylolisthesis</li>\n<li>Iatrogenic factors</li>\n<li>Post-traumatic</li>\n<li>Local infection</li>\n<li>Metabolic conditions</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anatomical Categories</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Central Stenosis:</strong> Involves the area between <span class=\"customMeta\" data-dictid=\"25d29169e3169277720246b37b93ef\">facet</span> joints; contains <span class=\"customMeta\" data-dictid=\"bec08dbe0c16927771864d7774d7b0\">dural</span> <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> and nerve roots. <strong>(Option B)</strong></li>\n<li><strong>Lateral Stenosis:</strong> defined by the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> border of the <span class=\"customMeta\" data-dictid=\"826ce1571f1692777186a0b6e02559\">dura</span> to the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> border of the pedicle; Contains traversing nerve roots.</li>\n<li><strong>Foraminal Stenosis: </strong>located under the pars; contains exiting nerve roots.</li>\n<li><strong>Extraforaminal Region:</strong> <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> to the pars; may be compressed by far <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> disc protrusions.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Commonly affects <strong>women</strong>. <strong>(Option C)</strong></li>\n<li>Complaints include aching, heaviness, numbness, and <span class=\"customMeta\" data-dictid=\"14d1b66f821692777194e77a2edc9f\">paresthesia</span> in thighs and legs.</li>\n<li><strong>Pain occurs after standing or walking for 5–10 minutes; relieved by sitting, squatting, or leaning (spinal claudication).</strong></li>\n<li>Patients may prefer walking uphill for symptom relief.</li>\n<li>Unilateral symptoms may indicate foraminal stenosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Symptoms may be reproduced through walking, and neurological deficits are rare but possible.</li>\n<li>Intact <span class=\"customMeta\" data-dictid=\"e272cdded916927771951d2337037d\">pedal</span> pulses and the absence of <span class=\"customMeta\" data-dictid=\"0ae7ad52281692777200ef75a10716\">trophic</span> skin changes help distinguish from <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> claudication.</li>\n<li><strong>Differential diagnosis:</strong> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">Vascular</span> claudication, <span class=\"customMeta\" data-dictid=\"c28d031bd31692777189aa73411316\">hip joint</span> pathology, and <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> <span class=\"customMeta\" data-dictid=\"2d9476094c16927771933bcb162f19\">neuropathy</span> have to be excluded</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>In absolute stenosis, the mid-sagittal <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> <span class=\"customMeta\" data-dictid=\"afb15e4a331692777186e495b370a1\">diameter</span> is &lt; 10 mm.</li>\n<li>In relative stenosis, mid-sagittal <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> <span class=\"customMeta\" data-dictid=\"afb15e4a331692777186e495b370a1\">diameter</span> is between 10–13 mm.</li>\n<li>MRI: Preferred</li>\n<li>CT myelography: Indicated if <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> is contraindicated and is useful for dynamic stenosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Conservative management:\n\t\t\t\t<ul>\n<li>First-line treatment for mild symptoms includes patient education, analgesics (e.g., paracetamol, NSAIDs), non-impact exercise, and <span class=\"customMeta\" data-dictid=\"6de01005f61692777187a3003970c7\">epidural</span> <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> injections.</li>\n</ul>\n</li>\n<li>Surgical Treatment:\n\t\t\t\t<ul>\n<li>Is indicated for severe symptoms or failure of conservative treatment.</li>\n<li>A <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"46a5e63f281692777185d3f56ea186\">decompression</span> needs to be done by methods like:\n\t\t\t\t\t<ul>\n<li>Laminectomy for central stenosis.</li>\n<li>Undercutting facetectomies and <span class=\"customMeta\" data-dictid=\"c6d5162a2816927771918bfaa5d7ec\">ligamentum</span> flavum removal for <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"e50e29a57b16927771978b2f6cff3e\">recess</span> stenosis.</li>\n</ul>\n</li>\n<li>Care is taken to preserve <span class=\"customMeta\" data-dictid=\"25d29169e3169277720246b37b93ef\">facet</span> joints to prevent instability.</li>\n<li>A <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> may be required for foraminal <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> and cases involving spondylolysis, spondylolisthesis, scoliosis, and kyphosis.</li>\n<li>The SPORT (Spine Patient Outcomes Research Trial) shows that surgery is a more cost-effective method than non-operative treatment.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:448px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stenosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disc herniation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually &gt;50 yrs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually &lt;50 yrs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Insidious</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sudden</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Positional changes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Sitting (flexion)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Better</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Worse</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Extension</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Worse</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Better</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fVDnJxbPRvmCq4Z3l1rx1743246857.mp3", "video": ""}, {"text": "A 10-year-old girl is brought to the clinic with complaints of low back pain and difficulty participating in sports. Examination reveals increased lumbar lordosis and a noticeable step at the L5-S1 level. Radiographs confirm the diagnosis. What is the most appropriate management for her condition?", "options": [{"label": "A", "text": "Immediate surgical intervention", "correct": false}, {"label": "B", "text": "Observation and activity modification", "correct": true}, {"label": "C", "text": "Epidural steroid injections", "correct": false}, {"label": "D", "text": "Physical therapy focused on extension exercises", "correct": false}], "correct_answer": "B. Observation and activity modification", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/KKfwbpsb1qDVHVHlMKcc1737956123.png", "https://image.prepladder.com/content/sU7Wx12ov1drZFb9RVBK1737955457.png", "https://image.prepladder.com/content/tfiUDj0wihl2Ax7oZTdQ1737955511.png", "https://image.prepladder.com/content/vMXOy3aThiLqukmgsOsg1737955556.png", "https://image.prepladder.com/content/SHYBVR35Q1kssDYYjInr1737955610.png", "https://image.prepladder.com/content/ScfLgzGwXvLQM4gd3y5f1737955687.png", "https://image.prepladder.com/content/kbFULfVNyHcD3st093vG1737955771.png", "https://image.prepladder.com/content/tB1EEgnce2MbL7e0gxrx1737955731.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:692px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Isthmic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Congenital</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Degenerative</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Asymptomatic or low back pain.</li>\n<li>History of trauma in 50% of cases.</li>\n<li>Common in both adults and children.</li>\n<li>Pain in lower back, buttocks, legs, and toes.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Known as <strong>pseudospondylolisthesis.</strong></li>\n<li>Intermittent symptoms, especially in the elderly.</li>\n<li>More common in women (5 times) and affects 4-10% of the population.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pain in the back, buttock, or thigh.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Deformity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Increased <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> lordosis.</strong></li>\n<li><strong>Palpable step at L5–S1</strong>.<strong>(Step sign)</strong></li>\n<li>Short torso, protruding abdomen.</li>\n<li>Transverse <span class=\"customMeta\" data-dictid=\"27efa994461692777203a9c1696153\">furrow</span> at L5.</li>\n<li>Vertical sacrum.</li>\n<li>Flat <span class=\"customMeta\" data-dictid=\"a0af4564cf1692777183e503d226f6\">buttocks</span> and <span class=\"customMeta\" data-dictid=\"760fca96ae1692777188e9c7443279\">hamstring</span> tightness.</li>\n<li><strong>Prominent L5 <span class=\"customMeta\" data-dictid=\"6ecc9fc8e416927771993c575ccc1e\">spinous</span> process</strong>.</li>\n<li>Scoliosis present in 13%.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Scoliosis and <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> waddle.</li>\n<li>Flat buttocks.</li>\n<li><strong>Stiffness of the spine</strong>; limited bending.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Stiffness of spine.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurological Issues</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rare involvement of L5 nerve root.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Involvement of <strong>L5 or S1 nerve root</strong>; L5 involvement is rare.</li>\n<li><strong>Neurological claudication</strong>.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Commonly affects L3–4.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Spondylolysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Spondylolisthesis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>\n<p>Resembles a<strong> Scottish dog</strong></p>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>\n<p><strong>Collar Appearance</strong>: Indicates a <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in the <span class=\"customMeta\" data-dictid=\"290782db561692777190e9766fc8ae\">isthmus</span> (pars interarticularis)</p>\n</li>\n<li>\n<p>Defect without vertebral displacement</p>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>\n<p><strong>Separated Head and Neck</strong></p>\n</li>\n<li>\n<p>Defect with vertebral displacement</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Frank Gaillard\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/scottie-dog-sign-spine\" data-tags=\"\" height=\"1888\" src=\"https://image.prepladder.com/content/sU7Wx12ov1drZFb9RVBK1737955457.png\" width=\"1888\"/>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Lucien Monfils\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:SpondylolisthesisL5S1.jpg\" data-tags=\"\" height=\"1888\" src=\"https://image.prepladder.com/content/tfiUDj0wihl2Ax7oZTdQ1737955511.png\" width=\"2869\"/></td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"><img alt=\"\" data-author=\" Jojo assumed\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Spondylolisthesis.jpg\" data-tags=\"\" height=\"3198\" src=\"https://image.prepladder.com/content/vMXOy3aThiLqukmgsOsg1737955556.png\" width=\"4167\"/></td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.thespineinstitute.com.au/Conditions/Spondylolisthesis/\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/SHYBVR35Q1kssDYYjInr1737955610.png\" width=\"4167\"/></td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Spondyloptosis </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/spondyloptosis\" data-tags=\"\" height=\"1000\" src=\"https://image.prepladder.com/content/kbFULfVNyHcD3st093vG1737955771.png\" width=\"1000\"/></p>\n</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/inverted-napoleon-hat-sign-2#image-65661797\" data-tags=\"\" height=\"1605\" src=\"https://image.prepladder.com/content/tB1EEgnce2MbL7e0gxrx1737955731.png\" width=\"850\"/></td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It refers to<strong> <span class=\"customMeta\" data-dictid=\"d4ae50897e16927771884b5c46ba7d\">grade</span> V spondylolisthesis</strong>, where a <span class=\"customMeta\" data-dictid=\"89cd4b5bf716927772010247b57941\">vertebra</span> has moved so far forward relative to the one below that their<strong> endplates no longer align</strong>.</li>\n<li>This condition typically involves <span class=\"customMeta\" data-dictid=\"06a5cd6625169277718153bce54fff\">anterolisthesis</span> of L5 over S1</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/kquaT3MVNSj4vui9Jbqk1743246539.mp3", "video": ""}, {"text": "A 25-year-old male athlete presents with lower back pain radiating to the left leg, exacerbated by physical activity. On examination, there is tenderness over the lower lumbar spine. X-rays reveal a defect in the pars interarticularis and a forward displacement of the L5 vertebra. Which type of spondylolisthesis is most likely in this patient?", "options": [{"label": "A", "text": "Dysplastic", "correct": false}, {"label": "B", "text": "Isthmic", "correct": true}, {"label": "C", "text": "Degenerative", "correct": false}, {"label": "D", "text": "Traumatic", "correct": false}], "correct_answer": "B. Isthmic", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/UWwPBpa9Ctst3swhKEeF1737794753.png", "https://image.prepladder.com/content/k8IgglTQBqm3tMGBXhYQ1737794803.png", "https://image.prepladder.com/content/3i8gSZJA88kErvFFQhza1737794832.png", "https://image.prepladder.com/content/4gxzPTTnkyJn6LRjoFqx1737794913.png", "https://image.prepladder.com/content/zPTMM0s5Vsxn6UyHmlyz1737794984.png", "https://image.prepladder.com/content/TiYGOp4E5XvF5JBiBG3U1737794952.png", "https://image.prepladder.com/content/gGapFKNydecFDcG5QFRT1737795004.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:695px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Spondylolisthesis</strong></p>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/UWwPBpa9Ctst3swhKEeF1737794753.png\" width=\"4167\"/>\n<ul>\n<li>It refers to the forward <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of a <span class=\"customMeta\" data-dictid=\"89cd4b5bf716927772010247b57941\">vertebra</span> over the one beneath it</li>\n<li>Commonly occurring at the L5-S1 and L4-L5 levels.</li>\n<li><strong>Spondylolysis </strong>refers to a<strong> <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in the <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> without</strong> the<strong> <span class=\"customMeta\" data-dictid=\"89cd4b5bf716927772010247b57941\">vertebra</span> slipping forward</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classification</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4168\" src=\"https://image.prepladder.com/content/k8IgglTQBqm3tMGBXhYQ1737794803.png\" width=\"4168\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dysplastic</strong><strong> (Option A)</strong></p>\n<ul>\n<li>Least common type</li>\n<li>Caused by <strong>congenital anomalies in the upper <span class=\"customMeta\" data-dictid=\"d7ea5b85641692777198096c6c80c2\">sacrum</span> or L5</strong> arch, facilitating the slip.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4168\" src=\"https://image.prepladder.com/content/3i8gSZJA88kErvFFQhza1737794832.png\" width=\"4168\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Isthmic</strong><strong> (Option B)</strong></p>\n<ul>\n<li>The most common type</li>\n<li>Involving a <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> in the <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> interarticularis, which can be further divided into three subtypes:</li>\n</ul>\n<ul>\n<li><strong>Lytic</strong>: A fatigue <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of the <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> interarticularis.</li>\n<li><strong>Intact but elongated</strong>: The <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> interarticularis remains intact but is elongated.</li>\n<li><strong>Acute fracture</strong>: A recent <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of the <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> interarticularis. The <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> causes the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> half of the <span class=\"customMeta\" data-dictid=\"89cd4b5bf716927772010247b57941\">vertebra</span> to slip forward while the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> half remains with the lower vertebra.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4168\" src=\"https://image.prepladder.com/content/4gxzPTTnkyJn6LRjoFqx1737794913.png\" width=\"4168\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Degenerative</strong><strong> (Option C)</strong></p>\n<ul>\n<li>Results from<strong> long-term <span class=\"customMeta\" data-dictid=\"52e6e2a0a11692777190b145ae5dc0\">intersegmental</span> instability</strong>, where the <strong>pars remains intact,</strong> but degenerative changes in the <span class=\"customMeta\" data-dictid=\"25d29169e3169277720246b37b93ef\">facet</span> joints permit forward slipping.</li>\n<li>Common in older adults, where <span class=\"customMeta\" data-dictid=\"acb259200b16927771908888d1377c\">instability</span> in the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"25d29169e3169277720246b37b93ef\">facet</span> joints due to <span class=\"customMeta\" data-dictid=\"720567fecd169277719411dda3d1a2\">osteoarthritis</span> can lead to displacement, occasionally backwards (retrolisthesis).</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> and neurological issues are rare.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/zPTMM0s5Vsxn6UyHmlyz1737794984.png\" width=\"4167\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Traumatic</strong><strong> (Option D)</strong></p>\n<p>This results from<strong> fractures</strong> in other parts of the<strong> bony structure</strong> <strong>rather </strong>than in the<strong> <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> interarticularis.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/TiYGOp4E5XvF5JBiBG3U1737794952.png\" width=\"4167\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathological</strong></p>\n<p>Caused by <strong>generalized</strong> or<strong> <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> bone diseases</strong> that weaken the vertebral articulations.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:346px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Percentage of Forward Displacement</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>G1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Up to 25%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>G2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>25% to 50%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>G3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>50% to 70%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>G4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Greater than 75%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>G5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;100% - Spondyloptosis</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/bnoyWtrAdyGGWUDShlHe1743246308.mp3", "video": ""}, {"text": "A 47-year-old male presents with low back pain radiating to the buttocks, thigh, and calf, which worsens when lifting heavy objects. He experiences numbness over the lateral side of his foot. On examination, there is a weakness of the plantar flexors of the foot and a sluggish ankle jerk. Straight-leg raising is positive, causing pain at 25 degrees. Which nerve root is most likely affected?", "options": [{"label": "A", "text": "L2 root", "correct": false}, {"label": "B", "text": "L4 root", "correct": false}, {"label": "C", "text": "L5 root", "correct": false}, {"label": "D", "text": "S1 root", "correct": true}], "correct_answer": "D. S1 root", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/BYmweySp8sTPQBCnn56E1737779969.png", "https://image.prepladder.com/content/mvqwZ7tEchbCO2x75dQs1737780032.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:585px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nerve Root Affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Motor Weakness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sensory Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reflexes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>L5–S1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>S1 root</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weakness of plantar-flexors of the foot</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Over the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> side of the foot</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ankle <span class=\"customMeta\" data-dictid=\"b88c1802e21692777190700ee5b998\">jerk</span> sluggish or absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>L4–L5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>L5 root <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weakness of <span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\">Extensor</span> hallucis <span class=\"customMeta\" data-dictid=\"7ff574b4f61692777191fa536b5e6c\">longus</span> and dorsiflexors of the foot</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Over the <span class=\"customMeta\" data-dictid=\"f61866c72d169277718680f9c96ff2\">dorsum</span> of the foot and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> side of the leg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ankle <span class=\"customMeta\" data-dictid=\"b88c1802e21692777190700ee5b998\">jerk</span> normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>L3–L4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>L4 root <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weakness of extensors of the knee</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Over the <span class=\"customMeta\" data-dictid=\"b3a1896d2d16927771886c0d03fc69\">great toe</span> and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> side of the leg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Knee <span class=\"customMeta\" data-dictid=\"b88c1802e21692777190700ee5b998\">jerk</span> sluggish or absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>L1-L4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>L2, L3, L4 roots <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weakness of hip <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> and adduction, knee extension</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Over the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> thigh and sometimes <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> lower leg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased patellar reflex</p>\n<h3> </h3>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:586px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age and Lifestyle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically affects adults aged 20-40, particularly those with a <span class=\"customMeta\" data-dictid=\"484e72500916927771982789485f51\">sedentary</span> lifestyle.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Low Back Pain (LBP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most common symptom.Can be <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> or chronic.</li>\n<li>Acute LBP: Intense pain and muscle spasms.</li>\n<li>Chronic LBP: Dull, worsened by exertion, relieved by rest.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sciatica</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pain radiating down the leg.</li>\n<li><strong>S1 root</strong> <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> causes pain to the postero-lateral calf and heel.</li>\n<li><strong>L5 root</strong> <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> affects the <span class=\"customMeta\" data-dictid=\"5a5df583551692777181550518132c\">anterolateral</span> leg and ankle.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurological Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Paresthesia (\"pins and needles\"), numbness, muscle weakness. In severe cases, <span class=\"customMeta\" data-dictid=\"657533bf1d16927771839f7875a8eb\">cauda</span> equina syndrome can occur, leading to <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> and incontinence.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The patient stands with a rigid <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> spine, and the trunk tilted forward or sideways (Sciatic tilt).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Movement Limitation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Restricted forward bending due to severe <span class=\"customMeta\" data-dictid=\"26866bac6f16927771940c1aedc2e4\">paraspinal</span> muscle spasm.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tenderness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diffuse <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> in the <span class=\"customMeta\" data-dictid=\"2d710fe8461692777191d18505790c\">lumbosacral</span> region, with <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> near <span class=\"customMeta\" data-dictid=\"6ecc9fc8e416927771993c575ccc1e\">spinous</span> processes in some cases.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:586px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Straight-leg Raising (SLR) Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The leg is raised until pain is felt in the buttock, thigh, or calf. Pain typically occurs between 30-70 degrees. Indicates <span class=\"customMeta\" data-dictid=\"2d710fe8461692777191d18505790c\">lumbosacral</span> root tension or disc prolapse.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lasègue's Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extension of the knee in a raised leg. Normally, the limb can be raised 80-90 degrees, but disc <span class=\"customMeta\" data-dictid=\"c49cc1bac4169277719692da7af2cc\">prolapse</span> reduces this to under 30 degrees due to severe pain. <span class=\"customMeta\" data-dictid=\"5c4883591b16927771863aa94323f0\">Dorsiflexion</span> of the foot worsens the pain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurological Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assesses motor weakness, <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> loss, or <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> loss corresponding to the affected nerve root. <strong>L5 root affects</strong> <span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\">extensor</span> hallucis longus, tested by <span class=\"customMeta\" data-dictid=\"5c4883591b16927771863aa94323f0\">dorsiflexion</span> of the big toe. <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">Sensory</span> loss in the corresponding dermatome.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/qFydBVFQKpgBKppvkR2H1745754121.mp3", "video": ""}, {"text": "A 45-year-old male presents with lower back pain radiating to his right leg. MRI reveals a disc prolapse at L4-L5. Which of the following is the correct sequence of changes leading to the prolapse?", "options": [{"label": "A", "text": "Fibrosis of the nucleus → Disc extrusion → Calcification of nucleus", "correct": false}, {"label": "B", "text": "Nucleus degeneration → Nucleus displacement → Fibrosis and calcification", "correct": true}, {"label": "C", "text": "Disc sequestration → Posterior longitudinal ligament thickening → Degeneration of nucleus", "correct": false}, {"label": "D", "text": "Disc extrusion → Nucleus degeneration → Compression of nerve roots", "correct": false}], "correct_answer": "B. Nucleus degeneration → Nucleus displacement → Fibrosis and calcification", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:586px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nucleus Degeneration</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Softening and <span class=\"customMeta\" data-dictid=\"c3bbd691781692777203582ec44b8c\">fragmentation</span> of the <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> pulposus</li>\n<li>Weakening and <span class=\"customMeta\" data-dictid=\"df4f1758e2169277718697ae66f3dd\">degeneration</span> of the <span class=\"customMeta\" data-dictid=\"2889a63cdd1692777181f9102ed608\">annulus</span> fibrosus</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nucleus Displacement</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Protrusion</strong>: Bulging of the <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> through a weakened <span class=\"customMeta\" data-dictid=\"2889a63cdd1692777181f9102ed608\">annulus</span> fibrosus</li>\n<li><strong>Extrusion</strong>: <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">Nucleus</span> extrudes through <span class=\"customMeta\" data-dictid=\"2889a63cdd1692777181f9102ed608\">annulus</span> but retains contact with the disc</li>\n<li><strong>Sequestration</strong>: <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">Nucleus</span> separates from the disc and becomes a free fragment</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fibrosis and Repair</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nucleus pulposus and the extruded material undergoes <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> and calcification</li>\n<li>New bone formation and <span class=\"customMeta\" data-dictid=\"77dc1bdd7416927771991cd9877b25\">spur</span> development at <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> <span class=\"customMeta\" data-dictid=\"ccd357daaf16927771825777ea6a0d\">attachment</span> sites, leading to <span class=\"customMeta\" data-dictid=\"77dc1bdd7416927771991cd9877b25\">spur</span> formation</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:586px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Secondary Changes</strong></h3>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Spinal <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">Canal</span> Changes</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Compression of <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> <span class=\"customMeta\" data-dictid=\"2ae158b0bc1692777200039e41de96\">theca</span> and <span class=\"customMeta\" data-dictid=\"64d06f977116927771936e3af9572f\">nerve roots</span> (usually one, occasionally multiple roots)</li>\n<li>The <strong>nerve root affected is usually the one exiting below the disc level.</strong></li>\n<li>Large <span class=\"customMeta\" data-dictid=\"c49cc1bac4169277719692da7af2cc\">prolapse</span> may cause <span class=\"customMeta\" data-dictid=\"657533bf1d16927771839f7875a8eb\">Cauda</span> equina syndrome</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intervertebral Joint Changes</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Loss of part of the <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> pulposus leads to fibrosis, reducing the height of the disc.</li>\n<li>Results in incongruence and degenerative <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> of the <span class=\"customMeta\" data-dictid=\"25d29169e3169277720246b37b93ef\">facet</span> joints.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/pw2DIUcAHYO2lvdkX3fo1743243981.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 30 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 32</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Metabolic Bone Diseases-Metabolic Disorders In Orthopedics - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 32</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 32 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 3-year-old child with achondroplasia presents with bowing of the legs. On examination, the legs appear bowed with the fibula longer than the tibia. Which imaging modality would be most helpful in assessing the characteristic skeletal deformities associated with achondroplasia?", "options": [{"label": "A", "text": "MRI", "correct": false}, {"label": "B", "text": "X-Ray", "correct": true}, {"label": "C", "text": "Ultrasound", "correct": false}, {"label": "D", "text": "CT Scan", "correct": false}], "correct_answer": "B. X-Ray", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/4uYoK7k884HjIqMKn85G1738037232.png", "https://image.prepladder.com/content/WbsiQVmpZu4mKTSLPIu31738037319.png", "https://image.prepladder.com/content/h3HomfdxJTz4pEkhRMWB1738037523.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:721px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-Ray Findings of Achondroplasia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vertebral scalloping</li>\n<li>Shortened Pedicles</li>\n<li>Thoracolumbar <span class=\"customMeta\" data-dictid=\"67deccee6a16927771911e0dcd1c3c\">Kyphosis</span> during <span class=\"customMeta\" data-dictid=\"663d16ec8e169277719095f74c9816\">infancy</span> is common.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Unknown author\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://pacs.de/term/achondroplasia#&amp;gid=1&amp;pid=1\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/4uYoK7k884HjIqMKn85G1738037232.png\" width=\"207\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Shortened and widened metacarpals, leading to \"trident\" hands.</p>\n<p> </p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Mostafa Elfeky\" data-hash=\"\" data-license=\"Procured by PL\" data-source=\"https://radiopaedia.org/articles/trident-hand?lang=us\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/WbsiQVmpZu4mKTSLPIu31738037319.png\" width=\"294\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Short femur</li>\n<li>Genu Varum</li>\n<li>Long fibula</li>\n<li>V-shaped <span class=\"customMeta\" data-dictid=\"3480d51034169277718862050fed12\">Growth Plate</span> at the upper tibia</li>\n<li>Champagne glass appearance of Pelvis</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Unknown author\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://pacs.de/term/achondroplasia#&amp;gid=1&amp;pid=17\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/h3HomfdxJTz4pEkhRMWB1738037523.png\" width=\"173\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/i8xgHNcTTC1rczIVqAoN1744108016.mp3", "video": ""}, {"text": "A 42-year-old woman visits her dentist with swelling and pain in her left lower jaw, along with difficulty chewing. She reports persistent bone pain, weakness, and fatigue. Recently, she has experienced kidney stones. X-rays of her jaw are shown below. Which of the following is the most likely diagnosis based on the findings in this patient?", "options": [{"label": "A", "text": "Osteosarcoma", "correct": false}, {"label": "B", "text": "Brown's tumour", "correct": true}, {"label": "C", "text": "Osteoclastoma", "correct": false}, {"label": "D", "text": "Osteoid osteoma", "correct": false}], "correct_answer": "B. Brown's tumour", "question_images": ["https://image.prepladder.com/content/6ZHpFvZsdXoewNNOkS1Y1738042324.png"], "explanation_images": ["https://image.prepladder.com/content/UemMxkGAWYpdeBxuB5h61738042561.png", "https://image.prepladder.com/content/hpGDvw4oW5zfqRKiIWMH1738042495.png", "https://image.prepladder.com/content/vJV5arW4w2mlnmUO0vkG1738042731.png", "https://image.prepladder.com/content/NsWqW7rQmkccPm57AkNF1738042854.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/P9XEj0uDS8PS3q2MXIpp1744179924.mp3", "video": ""}, {"text": "A newborn is delivered at term with severe skeletal deformities, including crumpled femora and beaded ribs. The infant is noted to have extreme bone fragility and dies shortly after birth due to respiratory complications. Which type of Osteogenesis Imperfecta (OI), according to the Sillence classification, is most consistent with these findings?", "options": [{"label": "A", "text": "Type I", "correct": false}, {"label": "B", "text": "Type II", "correct": true}, {"label": "C", "text": "Type III", "correct": false}, {"label": "D", "text": "Type IV", "correct": false}], "correct_answer": "B. Type II", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sillence <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> of <span class=\"customMeta\" data-dictid=\"aa5eaa8b7316927771940e3ae8dbe6\">Osteogenesis</span> Imperfecta</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type I</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Inheritance:</strong> Autosomal dominant</li>\n<li>Mildest form</li>\n<li>Reduced production of <span class=\"customMeta\" data-dictid=\"7892fe45ba1692777196c705571a65\">procollagen</span> (50% less collagen).</li>\n<li><strong>Bone characteristics:</strong> Generalized osteoporosis, bone fragility, frequent fractures, especially during childhood and <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> bone maturity.</li>\n<li><strong>Sclera appearance:</strong> <span class=\"customMeta\" data-dictid=\"bfcd06bb65169277718343a64fe150\">Blue sclera</span> due to thin <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue in the eyes.</li>\n<li><strong>Hearing loss:</strong> Conductive deafness</li>\n<li><strong>Growth:</strong> Mild stunting of growth.</li>\n<li><strong>Dental involvement:</strong> <span class=\"customMeta\" data-dictid=\"99ecad87271692777185a2590b0628\">Dentinogenesis</span> imperfecta.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Inheritance:</strong> Autosomal dominant</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"1304db17d3169277719684a316a8c4\">qualitative</span> <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> in <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> function (lethal <span class=\"customMeta\" data-dictid=\"a0d3680eab1692777195d6ab932b14\">perinatal</span> form).</li>\n<li><strong>Bone characteristics:</strong> Extreme bone fragility, fractures, and deformities (accordion femur), Delayed skull ossification.</li>\n<li><strong>Sclera:</strong> <span class=\"customMeta\" data-dictid=\"bfcd06bb65169277718343a64fe150\">Blue sclera</span> present.</li>\n<li><strong>Lethality:</strong> <span class=\"customMeta\" data-dictid=\"a0d3680eab1692777195d6ab932b14\">Perinatal</span> death due to extreme fragility.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type III</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Inheritance:</strong> Autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> or autosomal dominant.</li>\n<li>Both <span class=\"customMeta\" data-dictid=\"1304db17d3169277719684a316a8c4\">qualitative</span> and <span class=\"customMeta\" data-dictid=\"ef5cb829b8169277719603304e73cb\">quantitative</span> abnormalities in <span class=\"customMeta\" data-dictid=\"946a9a6be11692777201eb269e8327\">type I</span> collagen.</li>\n<li><strong>Bone characteristics:</strong> Moderate to severe bone fragility, multiple fractures, Marked long bone deformities, <span class=\"customMeta\" data-dictid=\"62a6c85ad51692777185af1f5463e1\">coxa</span> vara, and severe <span class=\"customMeta\" data-dictid=\"3243864c2316927771817341380a07\">ambulation</span> difficulties.</li>\n<li><strong>Sclera:</strong> <span class=\"customMeta\" data-dictid=\"bfcd06bb65169277718343a64fe150\">Blue sclera</span> in infancy, returning to normal hue in adolescence.</li>\n<li><strong>Other skeletal issues:</strong> Early onset scoliosis, triangular facies, <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> bossing, <span class=\"customMeta\" data-dictid=\"cf3585c06f1692777182cba3cb4c97\">basilar</span> invagination.</li>\n<li><strong>Stature:</strong> Extremely short stature, progressively worsens with age.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type IV </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Inheritance:</strong> Autosomal dominant.</li>\n<li>Qualitative and <span class=\"customMeta\" data-dictid=\"ef5cb829b8169277719603304e73cb\">quantitative</span> changes in <span class=\"customMeta\" data-dictid=\"946a9a6be11692777201eb269e8327\">type I</span> collagen.</li>\n<li><strong>Sclera:</strong> <strong>Normal sclera.</strong></li>\n<li><strong>Bone fragility:</strong> Moderate to severe bone <span class=\"customMeta\" data-dictid=\"0f4e78e9121692777203594ba840cc\">fragility</span> and deformity, especially in long bones and the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> column.</li>\n<li><strong>Growth:</strong> Moderate to severe growth stunting.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/kITKGzhidBMwHzFaDRHG1744111000.mp3", "video": ""}, {"text": "A 7 y/o girl is brought to the clinic with multiple fractures and a family history of bone fragility. An X-ray reveals several characteristic features, including wormian bones and thin cortices of the long bones. Which of the following radiological features is specific to osteogenesis imperfecta?", "options": [{"label": "A", "text": "Fracture deformities in the proximal femur", "correct": false}, {"label": "B", "text": "Scoliosis of the thoracic spine", "correct": false}, {"label": "C", "text": "Trumpet-like metaphysis", "correct": true}, {"label": "D", "text": "Bowing of the long bones", "correct": false}], "correct_answer": "C. Trumpet-like metaphysis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/DIlDtgp0aGvAVjNB4iPQ1738038964.png", "https://image.prepladder.com/content/R3dOOmHjkWyDgi93tjJq1738039025.png", "https://image.prepladder.com/content/oz7RpJf8krk40AoKl1st1738039101.png", "https://image.prepladder.com/content/uCN9faQJ5QIKwZ7DQGHn1738039158.png", "https://image.prepladder.com/content/PeKYC9PxwMpoSGho4Lx01738039817.png", "https://image.prepladder.com/content/onIYI4wks4ZigFxletPg1738039598.png", "https://image.prepladder.com/content/QmXS0IjkZo4K05UCz6gK1738039647.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Qm5uPPVlPbxrepjhaOLX1744177921.mp3", "video": ""}, {"text": "A 3 y/o child presents with multiple fractures, some in different stages of healing. There is concern from healthcare providers regarding the possibility of child abuse. Which of the following is most helpful in distinguishing osteogenesis imperfecta (OI) from Battered Baby Syndrome in a child with multiple fractures?", "options": [{"label": "A", "text": "Family history of similar bone fragility", "correct": true}, {"label": "B", "text": "Multiple fractures at different stages of healing", "correct": false}, {"label": "C", "text": "Elevated alkaline phosphatase", "correct": false}, {"label": "D", "text": "Skull fractures", "correct": false}], "correct_answer": "A. Family history of similar bone fragility", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/RHT9pPVF5w2tpJ7rwz4W1744178038.mp3", "video": ""}, {"text": "Which of the following management strategies is most effective for enhancing bone strength and reducing fracture risk in this child with osteogenesis imperfecta?", "options": [{"label": "A", "text": "Only physiotherapy and mobility aids", "correct": false}, {"label": "B", "text": "Administration of IV Zoledronate cycles", "correct": true}, {"label": "C", "text": "Sheffield procedure for bowed long bones", "correct": false}, {"label": "D", "text": "Sofield-Miller or Kebab Osteotomy", "correct": false}], "correct_answer": "B. Administration of IV Zoledronate cycles", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ZAr06pj81BKJ8rDYen0E1738040109.png", "https://image.prepladder.com/content/wjzBtb01nuVRRkIRGkEt1738040204.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/MBqnY9GV67lvQyFAZLpU1744178292.mp3", "video": ""}, {"text": "Which of the following statements regarding Parathyroid Hormone (PTH) and its effects on bone is FALSE?’", "options": [{"label": "A", "text": "PTH increases serum calcium levels by enhancing calcium release from bone.", "correct": false}, {"label": "B", "text": "Chronic exposure to PTH decreases the number of osteoblasts and osteoclasts.", "correct": true}, {"label": "C", "text": "Intermittent administration of PTH can lead to a net gain in bone mass.", "correct": false}, {"label": "D", "text": "PTH indirectly stimulates osteoclasts through cytokines released by osteoblasts.", "correct": false}], "correct_answer": "B. Chronic exposure to PTH decreases the number of osteoblasts and osteoclasts.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ttKNJvU7HvLa2QUCQ3UO1744178434.mp3", "video": ""}, {"text": "A 50-year-old man visits his physician due to persistent bone pain, particularly in his lower back and hips. His medical history includes fatigue and occasional kidney stones. X-rays are performed to evaluate his bone health. Which of the following X-ray findings is NOT typically associated with the possible condition of this patient?", "options": [{"label": "A", "text": "Sub-periosteal resorption of the phalanges", "correct": false}, {"label": "B", "text": "Brown's tumour in the maxilla.", "correct": false}, {"label": "C", "text": "\"Salt and pepper\" appearance of the skull", "correct": false}, {"label": "D", "text": "Osteoblastic lesions in the vertebrae", "correct": true}], "correct_answer": "D. Osteoblastic lesions in the vertebrae", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/9r5VBs3Nunsu06cU7vjI1738041300.png", "https://image.prepladder.com/content/wuDidwrb3nahSxQbmqbe1738041403.png", "https://image.prepladder.com/content/eWM25kLQQRQetCmcD8s21738041117.png", "https://image.prepladder.com/content/XIZlKjrO1OI2xbP0wkbG1738041702.png", "https://image.prepladder.com/content/eABRBAj6bie2mklNMdIV1738041565.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary Hyperparathyroidism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>About</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>An <span class=\"customMeta\" data-dictid=\"c3c9726266169277718021f4f0fa16\">adenoma</span> or <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">hyperplasia</span> of the <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> glands usually causes primary hyperparathyroidism.</li>\n<li>Clinical bone disease occurs in less than half of <span class=\"customMeta\" data-dictid=\"a21c150dc716927771893624a49628\">hyperparathyroidism</span> patients; they may present with either bone disease or <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> stones, but not both.</li>\n<li>More common in middle-aged women.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Bone Pains</strong>: <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">Tenderness</span> in bones, especially in lower limbs and back, with weakness and pallor.</li>\n<li><strong>Pathological Fractures</strong>: Fractures from trivial injuries, usually in the dorso-lumbar spine, neck of femur, and <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> rami.</li>\n<li><strong>Brown's Tumour</strong>: Expansile bone lesions made up of osteoclasts, often affecting the <span class=\"customMeta\" data-dictid=\"84514257721692777192f1748073bd\">maxilla</span> or mandible.</li>\n<li>Anorexia, nausea, vomiting, and <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> cramps.</li>\n<li><strong>Renal Colic</strong> and <span class=\"customMeta\" data-dictid=\"660645b0c91692777188bbdf3fedff\">hematuria</span> due to <strong>renal calculi.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Irregular, <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> bone rarefaction.</li>\n<li><strong>\"Salt and pepper\"</strong> appearance in skull bones. <strong>(Option C)</strong></li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Unknown author\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Hyperparathyroidism\" data-tags=\"\" height=\"350\" src=\"https://image.prepladder.com/content/9r5VBs3Nunsu06cU7vjI1738041300.png\" width=\"500\"/></p>\n\t\t\t \n\n\t\t\t<ul>\n<li>Loss of <span class=\"customMeta\" data-dictid=\"9864ad42b21692777191febeee1002\">lamina</span> <span class=\"customMeta\" data-dictid=\"826ce1571f1692777186a0b6e02559\">dura</span> around tooth sockets.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author='\"Cheng Xie Maria Tsakok Nia Taylor Karen Partington\"' data-hash=\"\" data-license=\"CC0\" data-source=\"https://www.researchgate.net/figure/On-the-orthopantomogram-OPG-there-is-a-single-well-defined-corticated-lucent-lesion_fig2_334758309\" data-tags=\"\" height=\"215\" src=\"https://image.prepladder.com/content/wuDidwrb3nahSxQbmqbe1738041403.png\" width=\"400\"/></p>\n<ul>\n<li>Sub-periosteal <span class=\"customMeta\" data-dictid=\"797daba8ca1692777197dc9f8d3a4a\">resorption</span> of <span class=\"customMeta\" data-dictid=\"27cd397275169277719513776c38c8\">phalanges</span> and clavicles - Most <strong>characteristic</strong> feature. <strong>(Option A)</strong></li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author='\"Jackson Bennett James W Suliburk Fanny Morón\"' data-hash=\"\" data-license=\"CC0\" data-source=\"https://www.researchgate.net/figure/Subperiosteal-resorption-of-the-radial-aspect-of-the-middle-phalanges-of-the-second-and_fig1_339432582\" data-tags=\"\" height=\"437\" src=\"https://image.prepladder.com/content/eWM25kLQQRQetCmcD8s21738041117.png\" width=\"400\"/></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Jyoti Panwar1,, Madhavi Kandagaddala1, Tameem Ahmad Bhat1, Charlie Chia-Tsong Hsu2, Poulomi Mitra1\" data-hash=\"\" data-license=\"CC BY NC SA 3.0\" data-source=\"https://mss-ijmsr.com/content/107/2020/2/1/img/IJMSR-2-003-g004.png\" data-tags=\"\" height=\"239\" src=\"https://image.prepladder.com/content/XIZlKjrO1OI2xbP0wkbG1738041702.png\" width=\"500\"/></p>\n<p> </p>\n<ul>\n<li>The central collapse of vertebral bodies and <span class=\"customMeta\" data-dictid=\"935f63fe4e169277718349fdd26737\">biconvex</span> discs in the spine.</li>\n<li>Coarse striations and cyst-like spaces in the <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> and other bones.</li>\n<li><strong>Brown's tumour</strong> resembles a bone tumour, often in the maxilla/mandible. <strong>(Option B)</strong></li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"N. IwasakiA. Minami\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.semanticscholar.org/paper/Brown-tumour-of-the-wrist-with-primary-Iwasaki-Minami/23cea70611ce2c893b206287b1ec0027fd4cbe3e/figure/0\" data-tags=\"\" height=\"484\" src=\"https://image.prepladder.com/content/eABRBAj6bie2mklNMdIV1738041565.png\" width=\"400\"/></p>\n<ul>\n<li>Extra-osseous features like <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> calculi.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Serum tests- High calcium, low phosphates, and high <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> phosphatase.</li>\n<li>Urinalysis- Low <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> and high <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> over 24 hours.</li>\n<li>CT scan- Assessing <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> glands and <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> <span class=\"customMeta\" data-dictid=\"058de735901692777194d0814ec3bc\">parathormone</span> secretion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> of hormone-secreting tissue.</li>\n<li>Orthopaedic Treatment: Protecting softened bones from stress; possible <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> of deformities after disease stabilization.</li>\n<li>Urology Treatment: Removal of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"eae898f16d1692777183cc3469a664\">calculi</span> and maintenance of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Hw5jPiZUQeC9SyKit5TV1744178650.mp3", "video": ""}, {"text": "A 45 y/o woman presents with muscle weakness and bone pain. Her laboratory results show the following: Serum calcium: 2.1 mmol/L (low) Serum phosphate: 0.8 mmol/L (low) Serum ALP: Elevated Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Primary hyperparathyroidism", "correct": false}, {"label": "B", "text": "Vitamin D deficiency", "correct": true}, {"label": "C", "text": "Paget's disease", "correct": false}, {"label": "D", "text": "Hypophosphatasia", "correct": false}], "correct_answer": "B. Vitamin D deficiency", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal Range</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Low (Causes)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High (Causes)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Calcium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2.2–2.6 mmol/L</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypoparathyroidism, <span class=\"customMeta\" data-dictid=\"77a4f731501692777202a03bfca9b4\">vitamin D</span> deficiency, chronic <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperparathyroidism, malignancy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Phosphate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.9–1.3 mmol/L</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vitamin D deficiency, <span class=\"customMeta\" data-dictid=\"5dda3cc2ab1692777202b3b3c65bea\">familial</span> hypophosphataemic rickets</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>ALP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal varies</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypophosphatasia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Osteomalacia, hyperparathyroidism, Paget’s, metastases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/F8fQEeP7Vashw28z0NWM1745756525.mp3", "video": ""}, {"text": "A 10-year-old girl presents with recurrent knee pain and multiple fractures from minor injuries. Examination shows normal sclera, bowed lower limbs, and height below the 10th percentile for her age. X-rays reveal long bone deformities. Which type of osteogenesis imperfecta is most likely in this patient?", "options": [{"label": "A", "text": "Type I", "correct": false}, {"label": "B", "text": "Type II", "correct": false}, {"label": "C", "text": "Type III", "correct": false}, {"label": "D", "text": "Type IV", "correct": true}], "correct_answer": "D. Type IV", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/n2635RMeEccDMXh3U04z1738038681.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sillence <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> of <span class=\"customMeta\" data-dictid=\"aa5eaa8b7316927771940e3ae8dbe6\">Osteogenesis</span> Imperfecta</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type I</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Inheritance:</strong> Autosomal dominant</li>\n<li>Mildest form</li>\n<li>Reduced production of <span class=\"customMeta\" data-dictid=\"7892fe45ba1692777196c705571a65\">procollagen</span> (50% less collagen).</li>\n<li><strong>Bone characteristics:</strong> Generalized osteoporosis, bone fragility, frequent fractures, especially during childhood and <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> bone maturity.</li>\n<li><strong>Sclera appearance:</strong> <span class=\"customMeta\" data-dictid=\"bfcd06bb65169277718343a64fe150\">Blue sclera</span> due to thin <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue in the eyes.</li>\n<li><strong>Hearing loss:</strong> Conductive deafness</li>\n<li><strong>Growth:</strong> Mild stunting of growth.</li>\n<li><strong>Dental involvement:</strong> <span class=\"customMeta\" data-dictid=\"99ecad87271692777185a2590b0628\">Dentinogenesis</span> imperfecta.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type II</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Inheritance:</strong> Autosomal dominant</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"1304db17d3169277719684a316a8c4\">qualitative</span> <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> in <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> function (lethal <span class=\"customMeta\" data-dictid=\"a0d3680eab1692777195d6ab932b14\">perinatal</span> form).</li>\n<li><strong>Bone characteristics:</strong> Extreme bone fragility, fractures, and deformities (accordion femur), Delayed skull ossification.</li>\n<li><strong>Sclera:</strong> <span class=\"customMeta\" data-dictid=\"bfcd06bb65169277718343a64fe150\">Blue sclera</span> present.</li>\n<li><strong>Lethality:</strong> <span class=\"customMeta\" data-dictid=\"a0d3680eab1692777195d6ab932b14\">Perinatal</span> death due to extreme fragility.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type III</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Inheritance:</strong> Autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> or autosomal dominant.</li>\n<li>Both <span class=\"customMeta\" data-dictid=\"1304db17d3169277719684a316a8c4\">qualitative</span> and <span class=\"customMeta\" data-dictid=\"ef5cb829b8169277719603304e73cb\">quantitative</span> abnormalities in <span class=\"customMeta\" data-dictid=\"946a9a6be11692777201eb269e8327\">type I</span> collagen.</li>\n<li><strong>Bone characteristics:</strong> Moderate to severe bone fragility, multiple fractures, Marked long bone deformities, <span class=\"customMeta\" data-dictid=\"62a6c85ad51692777185af1f5463e1\">coxa</span> vara, and severe <span class=\"customMeta\" data-dictid=\"3243864c2316927771817341380a07\">ambulation</span> difficulties.</li>\n<li><strong>Sclera:</strong> <span class=\"customMeta\" data-dictid=\"bfcd06bb65169277718343a64fe150\">Blue sclera</span> in infancy, returning to normal hue in adolescence.</li>\n<li><strong>Other skeletal issues:</strong> Early onset scoliosis, triangular facies, <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> bossing, <span class=\"customMeta\" data-dictid=\"cf3585c06f1692777182cba3cb4c97\">basilar</span> invagination.</li>\n<li><strong>Stature:</strong> Extremely short stature, progressively worsens with age.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Inheritance:</strong> Autosomal dominant.</li>\n<li>Qualitative and <span class=\"customMeta\" data-dictid=\"ef5cb829b8169277719603304e73cb\">quantitative</span> changes in <span class=\"customMeta\" data-dictid=\"946a9a6be11692777201eb269e8327\">type I</span> collagen.</li>\n<li><strong>Sclera:</strong> <strong>Normal sclera.</strong></li>\n<li><strong>Bone fragility:</strong> Moderate to severe bone <span class=\"customMeta\" data-dictid=\"0f4e78e9121692777203594ba840cc\">fragility</span> and deformity, especially in long bones and the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> column.</li>\n<li><strong>Growth:</strong> Moderate to severe growth stunting.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/sUSfCZOli6JQOzg4LQsW1744110868.mp3", "video": ""}, {"text": "A 12-year-old boy with chronic kidney disease presents with bone pain, weakness, leg deformities, dry skin, and itching. Lab tests show elevated phosphate, low calcium, and high parathyroid hormone levels. What is the likely diagnosis?", "options": [{"label": "A", "text": "Primary hyperparathyroidism", "correct": false}, {"label": "B", "text": "Hypercalcemia of malignancy", "correct": false}, {"label": "C", "text": "Secondary hyperparathyroidism", "correct": true}, {"label": "D", "text": "Paget's disease of bone", "correct": false}], "correct_answer": "C. Secondary hyperparathyroidism", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/1vmoc1tdSX11OtD7mMit1744180299.mp3", "video": ""}, {"text": "A 45-year-old man with hyperparathyroidism undergoes parathyroidectomy. Three days postoperatively, he developed muscle cramps, perioral numbness, and carpopedal spasms. Laboratory investigations reveal low serum calcium, phosphate, and magnesium levels. Alkaline phosphatase is elevated. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hypoparathyroidism", "correct": false}, {"label": "B", "text": "Hungry bone syndrome", "correct": true}, {"label": "C", "text": "Pseudohypoparathyroidism", "correct": false}, {"label": "D", "text": "Hypercalcemic crisis", "correct": false}], "correct_answer": "B. Hungry bone syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/v0g8WX189Vbmqq3pawaW1744181018.mp3", "video": ""}, {"text": "A 55 year old man presents with an acute onset of pain, redness, and swelling in his right big toe. He reports a history of heavy alcohol consumption and is on thiazide diuretics for hypertension. Blood tests reveal a serum uric acid level of 500 μmol/L. Which of the following is the most likely underlying pathophysiological mechanism for his condition?", "options": [{"label": "A", "text": "Overproduction of uric acid due to increased dietary purine intake", "correct": false}, {"label": "B", "text": "Reduced uric acid excretion due to renal impairment", "correct": true}, {"label": "C", "text": "Excessive conversion of uric acid to allantoin", "correct": false}, {"label": "D", "text": "Increased uricase activity in the liver", "correct": false}], "correct_answer": "B. Reduced uric acid excretion due to renal impairment", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Crystal deposition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monosodium <span class=\"customMeta\" data-dictid=\"41d0fc680516927772019afa9472e5\">urate</span> crystals deposit in joints and tissues due to hyperuricemia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Uric acid production &amp; breakdown</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uric acid is the final product of <span class=\"customMeta\" data-dictid=\"c03d9c910716927771961a9a2609b5\">purine</span> metabolism, primarily produced in the liver.</p>\n<ul>\n<li>Normal <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid levels: SUA &gt; 420 μmol/L in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> and &gt; 360 μmol/L in women.</li>\n<li>Uric acid then gets converted to allantoin.</li>\n<li>Humans <strong>lack</strong> <strong>uricase enzyme</strong>, preventing the <span class=\"customMeta\" data-dictid=\"903370f259169277718385f6060dd7\">breakdown</span> of <span class=\"customMeta\" data-dictid=\"41d0fc680516927772019afa9472e5\">urate</span> to <span class=\"customMeta\" data-dictid=\"eae976dfa31692777181804c2b20e7\">allantoin</span> (more soluble). This leads to hyperuricemia. <strong>(Options C&amp;D)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Renal <span class=\"customMeta\" data-dictid=\"41d0fc680516927772019afa9472e5\">urate</span> handling </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>90% of <span class=\"customMeta\" data-dictid=\"41d0fc680516927772019afa9472e5\">urate</span> is reabsorbed via URAT1 in the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"3ddb367f1c16927771854815522adf\">convoluted</span> tubules; further excretion/reabsorption occurs in <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> tubules.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Crystal formation factors </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Factors like pH, temperature, and the absence of natural inhibitors influence <span class=\"customMeta\" data-dictid=\"41d0fc680516927772019afa9472e5\">urate</span> crystallisation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/GWWM6k0bZvaPV0p6ezDj1744181205.mp3", "video": ""}, {"text": "Which of the following are TRUE regarding acute and chronic gout?", "options": [{"label": "A", "text": "Acute gout presents with tophi in the elbow joints", "correct": false}, {"label": "B", "text": "Acute gout presents with “Punched-out\" erosions on the X-ray", "correct": false}, {"label": "C", "text": "Chronic gout does not present with any significant X-ray changes.", "correct": false}, {"label": "D", "text": "Acute gout affects the first metatarsophalangeal joints (podagra)", "correct": true}], "correct_answer": "D. Acute gout affects the first metatarsophalangeal joints (podagra)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hhxFMe673poLXyPWZZey1738043161.png", "https://image.prepladder.com/content/GEMBaBYOCx854vt4AOET1738043239.png", "https://image.prepladder.com/content/5be6AYJugLa1XrH9Ug8Y1738043343.png", "https://image.prepladder.com/content/RkM5wzATsr0gu7Olyll71738043510.png", "https://image.prepladder.com/content/XOcpupBO3vBJ9d7noxVQ1738043643.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"0b216ac0561692777188160d9a8814\">Gout</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic <span class=\"customMeta\" data-dictid=\"0b216ac0561692777188160d9a8814\">Gout</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sudden, often at night</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gradual, over-repeated attacks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Progression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid, with severe pain within hours</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Progressive, with long-term joint damage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Joint involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>First <span class=\"customMeta\" data-dictid=\"eb06d1383216927771938c9eadb451\">MTP</span> joint (70% cases, podagra), knee, ankle, elbow, wrist</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multiple joints, <span class=\"customMeta\" data-dictid=\"23ed22c5821692777200820f6150ac\">tophi</span> in elbows, hands, ears <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Systemic symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fever, malaise, particularly in <span class=\"customMeta\" data-dictid=\"45ea6905f61692777196a0a0d5eada\">polyarticular</span> cases</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Resolution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Self-limiting, resolves in 5-7 days without treatment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Persistent joint <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> and <span class=\"customMeta\" data-dictid=\"d6ccfc448916927771877d9bde179f\">erosive</span> arthropathy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Tophi formation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present, with deposits of monosodium <span class=\"customMeta\" data-dictid=\"41d0fc680516927772019afa9472e5\">urate</span> crystals</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Radiographic changes </strong><strong>(Options B &amp; C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None or mild</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>\"Punched-out\" erosions with overhanging edges on radiographs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Comorbidities</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically none with <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> episodes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> syndrome, <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> disease</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/9dBJfQYoyHKZy9QUJ8EB1744194093.mp3", "video": ""}, {"text": "A 50 year old man presents with a sudden onset of severe pain and swelling in his left big toe, which started during the night. He has a history of recurrent episodes of similar pain. On examination, the joint is red, swollen, and extremely tender. To confirm the diagnosis of gout, which of the following investigations is considered the gold standard?", "options": [{"label": "A", "text": "Serum Uric Acid (SUA) levels", "correct": false}, {"label": "B", "text": "Synovial Fluid Analysis", "correct": true}, {"label": "C", "text": "Radiographic Imaging", "correct": false}, {"label": "D", "text": "Inflammatory Markers (ESR and CRP)", "correct": false}], "correct_answer": "B. Synovial Fluid Analysis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/kbMHZh5kF6CUVWGGdzi21738043853.png", "https://image.prepladder.com/content/Kyk0qHiFc7rLHT5QDyDB1738043911.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Serum <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">Uric</span> Acid (SUA) Levels </strong><strong>(Option A ruled out) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Identify <span class=\"customMeta\" data-dictid=\"e22be927921692777189c58bef4715\">hyperuricemia</span> and monitor ULT</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hyperuricemia: &gt;420 μmol/L (men), &gt;360 μmol/L (women)</li>\n<li>May be normal during <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> attacks</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Synovial Fluid Analysis</strong><strong> (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>The gold standard for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"0b216ac0561692777188160d9a8814\">gout</span> diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Needle-shaped <span class=\"customMeta\" data-dictid=\"41d0fc680516927772019afa9472e5\">urate</span> crystals</li>\n<li><strong>Strong negative birefringence</strong></li>\n<li>WBC count ≥2,000 cells/mm³</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Radiographic <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> </strong><strong>(Option C ruled out) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Evaluate chronic gout</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>\"Punched-out\" erosions with overhanging edges (this is also called <strong>Martel’s sign/ G sign</strong> of chronic gout).</li>\n<li>Tophi (radiopaque <span class=\"customMeta\" data-dictid=\"41d0fc680516927772019afa9472e5\">urate</span> deposits)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Inflammatory Markers </strong><strong>(Option D ruled out) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Assess <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> inflammation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Elevated ESR</li>\n<li>Elevated CRP</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Other Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Screen for comorbidities</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Abnormal <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> profile</li>\n<li>Abnormal blood glucose</li>\n<li>Liver function abnormalities in related conditions</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fOenQPuEb5IJw0N7BYKg1744194354.mp3", "video": ""}, {"text": "A 58 year old male presents with a sudden onset of severe pain and swelling in his right big toe. His medical history includes hypertension and obesity. On examination, there is erythema and tenderness over the affected joint. A diagnosis of acute gout is made. Which of the following is the most appropriate initial treatment for this patient?", "options": [{"label": "A", "text": "Oral colchicine", "correct": false}, {"label": "B", "text": "Intra-articular corticosteroid injection", "correct": false}, {"label": "C", "text": "Non-steroidal anti-inflammatory drugs (NSAIDs)", "correct": true}, {"label": "D", "text": "Xanthine oxidase inhibitors", "correct": false}], "correct_answer": "C. Non-steroidal anti-inflammatory drugs (NSAIDs)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Ub1T0EkbB5vqSXlyK1A21738044099.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment of Gout</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute Gout</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>First-line Treatment </strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>NSAIDs preferred (e.g., indomethacin, naproxen, etoricoxib).</li>\n<li>\"Decrescendo\" regimen: Start high doses, and taper over 5-7 days.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Alternatives </strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Steroids if NSAIDs are unsuitable. <strong>(Option B ruled out)</strong></li>\n<li>Administration route: Intra-articular, oral, or intramuscular.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Colchicine</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Effective but limited by <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> side effects (e.g., diarrhoea). <strong>(Option A ruled out)</strong></li>\n<li>Early <span class=\"customMeta\" data-dictid=\"a4f93a26c11692777190f1659fa7c9\">initiation</span> and gradual tapering are recommended.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Non-drug Measures </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rest, ice packs, splinting, strong analgesia.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic Gout</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Patient Education </strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Educate on <span class=\"customMeta\" data-dictid=\"0b216ac0561692777188160d9a8814\">gout</span> management.</li>\n<li>Lifestyle modifications: Weight loss, <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> alcohol and <span class=\"customMeta\" data-dictid=\"d5bac53d50169277720363f48a6b3a\">fructose</span> intake.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Urate-Lowering Therapy (ULT) </strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Goal:</strong> Lower <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid (SUA) below the <span class=\"customMeta\" data-dictid=\"e4696a0f8d169277719865588e55c7\">saturation</span> point.</li>\n<li>Target SUA Levels: EULAR (European League Against Rheumatism) &lt;360 μmol/L; BSR (The British Society for Rheumatology) &lt;300 μmol/L.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Indications for ULT </strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recurrent <span class=\"customMeta\" data-dictid=\"0b216ac0561692777188160d9a8814\">gout</span> attacks.</li>\n<li>Chronic gouty arthropathy, tophi, <span class=\"customMeta\" data-dictid=\"41d0fc680516927772019afa9472e5\">urate</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> stones.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Shared Decision-Making </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Initiate lifelong ULT with patient involvement.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>First-Line ULT Agents </strong><strong> </strong></p>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Xanthine <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">Oxidase</span> Inhibitors</strong>: Reduce <span class=\"customMeta\" data-dictid=\"41d0fc680516927772019afa9472e5\">urate</span> formation.</li>\n<li><strong>Allopurinol</strong>: Drug of choice.</li>\n<li>Starting dose: 100 mg/day, lower for elderly/renal impairment.</li>\n<li>Dose <span class=\"customMeta\" data-dictid=\"38938f6b8f16927772000e7292bb2e\">titration</span> until target SUA is achieved.</li>\n<li><strong>Febuxostat</strong>: Alternative for <span class=\"customMeta\" data-dictid=\"6337926de316927771812a6842721f\">allopurinol</span> intolerance.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Other ULT Agents </strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Uricosurics</strong>: Enhance <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"41d0fc680516927772019afa9472e5\">urate</span> excretion.</li>\n<li>Examples: Probenecid, sulphinpyrazone, and <span class=\"customMeta\" data-dictid=\"566fe42b221692777182a413047549\">benzbromarone</span> (limited availability).</li>\n<li>Generally less effective than allopurinol.</li>\n<li>Contraindicated in urolithiasis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/hvIbB0QPI7AS57TRjDa51744194523.mp3", "video": ""}, {"text": "Which of the following statements about pseudogout is false?", "options": [{"label": "A", "text": "Pseudogout is due to calcium pyrophosphate crystal deposition in joints.", "correct": false}, {"label": "B", "text": "NSAIDs are the first-line treatment for acute pseudogout attacks.", "correct": false}, {"label": "C", "text": "Corticosteroid injections are contraindicated for acute pseudogout.", "correct": true}, {"label": "D", "text": "Acute pseudogout presents with sudden onset and elevated inflammatory markers.", "correct": false}], "correct_answer": "C. Corticosteroid injections are contraindicated for acute pseudogout.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/0d0JIbz1i3NSdUm086vH1738044239.png", "https://image.prepladder.com/content/vfrA4OTStPJpQnk3B0Kn1738044353.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Asymptomatic <span class=\"customMeta\" data-dictid=\"404309af341692777185bde29f7d07\">CPPD</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presence of <span class=\"customMeta\" data-dictid=\"940b4b015c1692777185ffed9cddfc\">CPP</span> crystals without noticeable symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"940b4b015c1692777185ffed9cddfc\">CPP</span> <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">Arthritis</span> (Pseudogout) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sudden onset of joint inflammation, mimicking gout. <span class=\"customMeta\" data-dictid=\"55a682d72e16927771865bb4855ba3\">Differentiation</span> from <span class=\"customMeta\" data-dictid=\"0b216ac0561692777188160d9a8814\">gout</span> becomes difficult, especially if the first <span class=\"customMeta\" data-dictid=\"eb06d1383216927771938c9eadb451\">MTP</span> is involved (Pseudopodagra).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Osteoarthritis (OA) with CPPD</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Coexistence with OA, hypertrophic <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> with prominent <span class=\"customMeta\" data-dictid=\"cde0c9ebe916927771941d2c6a06a8\">osteophyte</span> formation and synovitis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Chronic <span class=\"customMeta\" data-dictid=\"940b4b015c1692777185ffed9cddfc\">CPP</span> Crystal <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">Inflammatory</span> <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">Arthritis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Persistent joint inflammation, resembling <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">rheumatoid</span> arthritis, with <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">intermittent</span> <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> flares.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assess affected joints for pain, swelling, warmth, tenderness, and motion limitations.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Synovial Fluid Analysis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aspiration allows the identification of <span class=\"customMeta\" data-dictid=\"940b4b015c1692777185ffed9cddfc\">CPP</span> crystals; harder to detect than <span class=\"customMeta\" data-dictid=\"41d0fc680516927772019afa9472e5\">urate</span> crystals.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laboratory Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated <span class=\"customMeta\" data-dictid=\"49069760291692777187e0e72db819\">ESR</span> and <span class=\"customMeta\" data-dictid=\"4df81a22571692777185a288d3c63d\">CRP</span> during <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> flares indicate inflammation. <strong>(Option D ruled out) </strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gout</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pseudogout</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Crystal Composition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monosodium <span class=\"customMeta\" data-dictid=\"41d0fc680516927772019afa9472e5\">urate</span> (MSU) crystals</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Calcium <span class=\"customMeta\" data-dictid=\"53da8f40b5169277719620504e0cb9\">pyrophosphate</span> <span class=\"customMeta\" data-dictid=\"168c514d4016927771861c453b7a5a\">dihydrate</span> (CPPD)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Crystal Shape</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Needle-shaped</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rhomboid-shaped</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Birefringence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Colour (Polarized Light)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yellow when <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to the compensator</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blue when <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to the compensator</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute pain, redness, swelling, podagra</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Affects large joints, osteoarthritis-like symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Common Triggers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diet, medications, stress</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trauma, surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Demographics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Middle-aged men, <span class=\"customMeta\" data-dictid=\"c9ba8fa63616927771962d84263e40\">postmenopausal</span> women</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Affects both genders equally, older adults</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/kYJLASDGVMo6JDsOj47P1744195030.mp3", "video": ""}, {"text": "A 5 y/o boy is brought to the emergency department with a history of frequent fractures and deformities of the legs. His family reports that he has not been getting enough sunlight due to living in a region with long winters and has a diet low in dairy products. Laboratory tests show low serum levels of 1,25-OHD and elevated parathyroid hormone levels. What is the most likely diagnosis for this child?", "options": [{"label": "A", "text": "Calcipenic Rickets", "correct": true}, {"label": "B", "text": "Phosphopenic Rickets", "correct": false}, {"label": "C", "text": "Osteomalacia", "correct": false}, {"label": "D", "text": "Osteoporosis", "correct": false}], "correct_answer": "A. Calcipenic Rickets", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:603px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Calcipenic Rickets</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Phosphopenic Rickets</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Inadequate <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> (often <span class=\"customMeta\" data-dictid=\"77a4f731501692777202a03bfca9b4\">vitamin D</span> deficiency)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>PHEX or FGF23 gene mutations</li>\n<li>Intestinal <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> absorption</li>\n<li>Impaired or <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> excretion. <strong>(Option B ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Calcium Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Low <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> leads to hypocalcemia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Normal or variable <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> levels</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Phosphate Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Hypophosphatemia due to a decrease in <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> resorption.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Hypophosphatemia due to <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> or intestinal issues</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pathophysiological Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Activation of the parathyroid–bone <span class=\"customMeta\" data-dictid=\"3c28fd47f71692777182efbbaa5f6d\">axis</span> for <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> preservation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Defective <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> or transport</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Associated Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Primarily <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to <span class=\"customMeta\" data-dictid=\"77a4f731501692777202a03bfca9b4\">vitamin D</span> deficiency</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Can be associated with conditions like Fanconi syndrome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Effect on Growth Plate</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Reduced <span class=\"customMeta\" data-dictid=\"4bfa3e6f2c1692777181c53b124cf7\">apoptosis</span> of hypertrophic chondrocytes due to hypophosphatemia</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/uWMXE9Ovp6kSNDf6gkyB1744093593.mp3", "video": ""}, {"text": "A 6-month-old infant is brought to the pediatric clinic due to multiple fractures, which the parents report occurred with minimal trauma. On examination, the infant has noticeable bowing of the long bones. The physician suspects a hereditary connective tissue disorder. What is the most likely classification of this condition?", "options": [{"label": "A", "text": "Osteogenesis imperfecta tarda type I", "correct": true}, {"label": "B", "text": "Osteogenesis imperfecta tarda type II", "correct": false}, {"label": "C", "text": "Osteogenesis imperfecta congenita", "correct": false}, {"label": "D", "text": "Both A and C", "correct": false}], "correct_answer": "A. Osteogenesis imperfecta tarda type I", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Osteogenesis Imperfecta (OI) - Classifications</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Looser <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>OI Congenita</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Characterized by the presence of numerous fractures at birth.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>OI Tarda</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fractures occur after the <span class=\"customMeta\" data-dictid=\"a0d3680eab1692777195d6ab932b14\">perinatal</span> period</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Falvo <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>OI tarda Type I</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Features <strong>bowing of long bones</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>OI tarda Type II</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No bowing of long bones, with fractures being rare in this type.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Seedorff <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tarda Gravis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fractures occurring in infancy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tarda Lewis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fractures occurring in late childhood</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/XZe7pNGmYZhpVZInrBq41744110671.mp3", "video": ""}, {"text": "A 3 year old child with osteopetrosis presents with symptoms of cranial nerve compression. What is the characteristic X-ray finding most likely present in this patient?", "options": [{"label": "A", "text": "Rugger-Jersey Spine", "correct": true}, {"label": "B", "text": "Thinning of skull bones", "correct": false}, {"label": "C", "text": "Widened medullary canals", "correct": false}, {"label": "D", "text": "Decreased bone density", "correct": false}], "correct_answer": "A. Rugger-Jersey Spine", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/CHd7qNYGsohePc110Q4W1738038366.png", "https://image.prepladder.com/content/Qoh2ikSU7kURh3vkVMdo1738038424.png", "https://image.prepladder.com/content/oNpNzfFG5pkycYn1gfds1738038511.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray findings in osteopetrosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rugger Jersey Spine (Also seen in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> osteodystrophy)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sandwich Vertebra</strong></p>\n<p>Endplates of the <span class=\"customMeta\" data-dictid=\"89cd4b5bf716927772010247b57941\">vertebra</span> become densely <span class=\"customMeta\" data-dictid=\"934e9f88af169277719847f1a0728f\">sclerotic</span> resembling a sandwich.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Densely <span class=\"customMeta\" data-dictid=\"934e9f88af169277719847f1a0728f\">Sclerotic</span> bones</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Anish A. Patel, Rohit Ramanathan, Joshua Kuban, and Marc H. Willis\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:CT_of_rugger-jersey_spine_of_renal_osteodystrophy.jpg\" data-tags=\"\" height=\"401\" src=\"https://image.prepladder.com/content/CHd7qNYGsohePc110Q4W1738038366.png\" width=\"204\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Dr Maulik S Patel\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Osteopetrosis-4.jpg\" data-tags=\"\" height=\"485\" src=\"https://image.prepladder.com/content/Qoh2ikSU7kURh3vkVMdo1738038424.png\" width=\"400\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Unknown author\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://www.wikiwand.com/en/articles/Osteopetrosis\" data-tags=\"\" height=\"304\" src=\"https://image.prepladder.com/content/oNpNzfFG5pkycYn1gfds1738038511.png\" width=\"400\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ioHYGUyr0heiSLCS5nHe1744110190.mp3", "video": ""}, {"text": "Which of the following is a feature of Infantile Malignant Osteopetrosis?", "options": [{"label": "A", "text": "Normal bone resorption", "correct": false}, {"label": "B", "text": "Autosomal dominant inheritance", "correct": false}, {"label": "C", "text": "Early onset growth retardation", "correct": true}, {"label": "D", "text": "Asymptomatic presentation in adulthood", "correct": false}], "correct_answer": "C. Early onset growth retardation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Osteopetrosis</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Osteopetrosis, also known as Albers-Schönberg disease, is a rare condition characterized by abnormally dense bones due to <span class=\"customMeta\" data-dictid=\"144d78fe4816927771852de984c62f\">defective</span> <span class=\"customMeta\" data-dictid=\"c21bdae5e116927771947204c2076c\">osteoclast</span> function, which impairs bone resorption.</p>\n<p>As a result, bones become thickened but brittle, leading to structural abnormalities and complications. <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infantile <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">Malignant</span> <span class=\"customMeta\" data-dictid=\"4f3d56310a16927771941d13dfb53c\">Osteopetrosis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adult <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">Benign</span> <span class=\"customMeta\" data-dictid=\"4f3d56310a16927771941d13dfb53c\">Osteopetrosis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autosomal recessive</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inheritance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autosomal dominant</p>\n<p><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early onset with severe symptoms, including growth retardation, </strong>genu valgum, <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> skull development, <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve entrapment, pancytopenia, and hepatosplenomegaly.</p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> and discovered incidentally in adulthood. When symptomatic, it may present with non-specific bone pain, compressive neuropathies, and <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> fractures.</p>\n<p><strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased risk of hydrocephalus, hearing loss, and <span class=\"customMeta\" data-dictid=\"dc4ced4b86169277719422ad2689a5\">osteitis</span> of the mandible.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Delayed union</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptom management with vitamin D, γ-interferon, erythropoietin, and corticosteroids.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generally not required unless symptoms are present. <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">Symptomatic</span> management includes pain relief and <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> care.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/TCStNYGoWv9EpRRg0hgm1744110100.mp3", "video": ""}, {"text": "A 30 year old male with achondroplasia complains of progressive lower limb pain, numbness, and difficulty walking. Imaging reveals lumbar spinal stenosis. What is the initial management plan for this patient?", "options": [{"label": "A", "text": "Surgical spinal decompression", "correct": false}, {"label": "B", "text": "Weight loss and activity modification", "correct": true}, {"label": "C", "text": "Limb lengthening surgery", "correct": false}, {"label": "D", "text": "Total knee replacement", "correct": false}], "correct_answer": "B. Weight loss and activity modification", "question_images": ["https://image.prepladder.com/content/9i3qxOT6fdjWPeABAMpN1738037916.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment of Achondroplasia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management of <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">Spinal</span> Cord Compression</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proximal <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord compression, especially at the <span class=\"customMeta\" data-dictid=\"9f027343dd16927772039cf6b0c8e4\">foramen</span> magnum, is a life-threatening issue in infancy. Urgent <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"46a5e63f281692777185d3f56ea186\">decompression</span> and <span class=\"customMeta\" data-dictid=\"6694ddb1db1692777199c9a1e38bf0\">stabilization</span> are necessary when significant <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> is detected and if initial treatment is not beneficial.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management of <span class=\"customMeta\" data-dictid=\"4c815174781692777190e1b4a5d704\">Infantile</span> Kyphoscoliosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Kyphoscoliosis is common in infants with <span class=\"customMeta\" data-dictid=\"84c2a94b4816927771808fda49000d\">achondroplasia</span> but often resolves once independent sitting and standing are achieved.</li>\n<li>Bracing can be used for persistent deformities, while surgery (e.g., <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> strut <span class=\"customMeta\" data-dictid=\"05d44a78cc169277718581c62c6943\">corpectomy</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> fusion) is considered for severe cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Limb <span class=\"customMeta\" data-dictid=\"937e51c07a1692777191a776c47e3d\">Malalignment</span> and Lengthening Treatment</strong></p>\n<p><strong>(Options C and D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><u>Guided Growth</u>: Used in skeletally <span class=\"customMeta\" data-dictid=\"c219021c491692777189d289f1fc03\">immature</span> patients to correct limb <span class=\"customMeta\" data-dictid=\"3c0c325f4216927771819e5d0eb581\">alignment</span> with minimal invasiveness.</li>\n<li><u>Realignment Osteotomies</u>: For skeletally <span class=\"customMeta\" data-dictid=\"0472620c171692777192c655af9c57\">mature</span> patients, this surgery may be combined with limb lengthening or considered for severe malalignment.</li>\n<li>This surgery can increase height in individuals with <span class=\"customMeta\" data-dictid=\"84c2a94b4816927771808fda49000d\">achondroplasia</span> but carries risks such as non-union of bones, infection, nerve damage, and limb length discrepancies.</li>\n<li><u>Knee Replacement</u>: Total knee replacement is an option for joint pain due to advanced degeneration.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management of <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">Lumbar</span> <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">Spinal</span> Stenosis</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>For <strong>lumbar stenosis, initial management includes weight loss, physical therapy, and modifying activities.</strong> Surgery is considered if non-operative measures fail.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/CryskWLsL2agu0QEZOZ61744108813.mp3", "video": ""}, {"text": "A 5 year old child presents with significant short stature, disproportionate limb shortening, and distinctive facial features, including frontal bossing and a button nose. The child’s developmental milestones are appropriate for age. Which of the following bone diseases is most likely responsible for this child's clinical presentation?", "options": [{"label": "A", "text": "Osteogenesis imperfecta", "correct": false}, {"label": "B", "text": "Hypochondroplasia", "correct": false}, {"label": "C", "text": "Achondroplasia", "correct": true}, {"label": "D", "text": "Turner syndrome", "correct": false}], "correct_answer": "C. Achondroplasia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Efnh3RlEbNKJnE7zEQCO1738036499.png", "https://image.prepladder.com/content/zTV6uP8YUerFaqqcNGrz1738036587.png", "https://image.prepladder.com/content/tm4rWWNTgNwmxtFfpAK41738036678.png", "https://image.prepladder.com/content/tE5cBvsaAenHHMAMiT7V1738036794.png", "https://image.prepladder.com/content/p9wfKY2fEZ7R3b5rAU3K1738036829.png", "https://image.prepladder.com/content/nAp3nfyQqYco2yfSlJFS1738036884.png", "https://image.prepladder.com/content/KFciHeAtpiKn5uLv56hQ1738036946.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Disproportionate <span class=\"customMeta\" data-dictid=\"89170298ec1692777198eac32ce789\">Short Stature</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Significant reduction in height due to short limbs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Rhizomelic Shortening </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Shortening mainly affects <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> segments (humeri and femora).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Characteristic <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">Facial</span> Features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Button nose</li>\n<li>Frontal bossing</li>\n<li>Macrocephaly</li>\n<li>Midface hypoplasia</li>\n<li>Small <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> bridge</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Spinal Complications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Spinal Stenosis: Narrowing of the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> causing claudication.</li>\n<li>Proximal <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">Spinal</span> Cord Compression: This may lead to sleep apnoea in <span class=\"customMeta\" data-dictid=\"663d16ec8e169277719095f74c9816\">infancy</span> due to <span class=\"customMeta\" data-dictid=\"9f027343dd16927772039cf6b0c8e4\">foramen</span> <span class=\"customMeta\" data-dictid=\"8b30f6b0351692777191c9482a965e\">magnum</span> narrowing.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Skeletal Abnormalities</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Champagne glass pelvis</li>\n<li>Horizontal acetabulae</li>\n<li>Coxa vara</li>\n<li>Bulbous <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> femora</li>\n<li>Inverted \"V\" shape of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> epiphysis</li>\n<li>Genu varum</li>\n<li>\"Trident hands\" due to <span class=\"customMeta\" data-dictid=\"3582e886271692777192ab233546a6\">metacarpal</span> shortening and splaying</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Joint <span class=\"customMeta\" data-dictid=\"6f158cd2c11692777191fbc6ef31ac\">Laxity</span> and <span class=\"customMeta\" data-dictid=\"b6a968ad961692777189ce6955627a\">Hypotonia</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Causes postural issues such as:</p>\n<ul>\n<li>Flat feet</li>\n<li>Coronal malalignment</li>\n<li>Fixed hip flexion</li>\n<li>Lumbar lordosis</li>\n<li>Radial head subluxation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Normal Intelligence and Lifespan </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Individuals typically have normal intelligence and a lifespan comparable to the general population.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/HjB2Bcx09gHwvSfKOTFl1744107367.mp3", "video": ""}, {"text": "A 65 y/o woman undergoes a DEXA scan. Her T-score is reported as -2.8. What is the most appropriate interpretation of this result?", "options": [{"label": "A", "text": "Normal bone mass", "correct": false}, {"label": "B", "text": "Osteopenia", "correct": false}, {"label": "C", "text": "Osteoporosis", "correct": true}, {"label": "D", "text": "Fracture risk is negligible", "correct": false}], "correct_answer": "C. Osteoporosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/NRAcJvZUcykfLNNODquG1744107222.mp3", "video": ""}, {"text": "Which of the following is not a complication associated with Paget's disease?", "options": [{"label": "A", "text": "Osteosarcoma", "correct": false}, {"label": "B", "text": "Hypercalcaemia", "correct": false}, {"label": "C", "text": "Osteoporosis", "correct": true}, {"label": "D", "text": "Nerve compression", "correct": false}], "correct_answer": "C. Osteoporosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptom/Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cranial nerve compression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Causes vision impairment, <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> palsy, <span class=\"customMeta\" data-dictid=\"6d1eb38ecf1692777200bb65bbdefb\">trigeminal</span> neuralgia, or <span class=\"customMeta\" data-dictid=\"696dd98be71692777185b10993da3e\">deafness</span> (otosclerosis).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Spinal cord/nerve root <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vertebral thickening leads to neurological symptoms (e.g., pain, and weakness). <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Steal syndromes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diverted <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> (from visceral organs to the surrounding skeleton) causes cerebral <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> or <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord ischemia; may present as <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> <span class=\"customMeta\" data-dictid=\"f01241cd50169277718482b7ac00eb\">claudication</span> and <span class=\"customMeta\" data-dictid=\"cbc1f41317169277719185421a8e5a\">lower limb</span> weakness.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Fractures </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common in weight-bearing bones, it slow healing, and can be painful.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Osteoarthritis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically affects hip or knee, especially with <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> bone involvement.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Osteosarcoma </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> transformation (~1%), presents with increasing pain, swelling, and tenderness. <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>High-output <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> failure </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare, results from increased <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> to affected bones overloading the heart.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Hypercalcaemia </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs due to prolonged immobilisation. <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Excessive <span class=\"customMeta\" data-dictid=\"a489e669011692777190af3dd98ed4\">intraoperative</span> <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgery on <span class=\"customMeta\" data-dictid=\"f0113bf97f16927771941f6ab25ef2\">pagetic</span> bone results in increased bleeding.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fBa7YbeQb0DT6CHZg0qk1744096112.mp3", "video": ""}, {"text": "A 72 year old man with a history of Paget's disease of bone presents with worsening pain in his left hip and difficulty walking. Upon examination, his left hip is warm to the touch, and he has a noticeable deformity in the femur. Laboratory tests show elevated serum alkaline phosphatase (ALP) levels. X-rays reveal thickened femoral cortices with evidence of a stress fracture. What is the most appropriate initial management for this patient?", "options": [{"label": "A", "text": "Surgical fixation of the femur", "correct": false}, {"label": "B", "text": "Intravenous zoledronate therapy", "correct": true}, {"label": "C", "text": "Physical therapy and analgesics", "correct": false}, {"label": "D", "text": "Total hip replacement", "correct": false}], "correct_answer": "B. Intravenous zoledronate therapy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biochemical Investigations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Serum <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">Alkaline</span> <span class=\"customMeta\" data-dictid=\"65f1c4f3d4169277719505249503e0\">Phosphatase</span> (ALP) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Elevated in most cases; indicates increased osteoblastic activity.</li>\n<li>Reflects disease extent and monitors treatment response.</li>\n<li>Normal in <span class=\"customMeta\" data-dictid=\"bb410fd852169277719274df3a296f\">monostotic</span> PDB.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Serum <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">Calcium</span> and <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">Phosphate</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually normal; may be elevated in prolonged immobilisation.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>X-Ray Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Early stage</strong>: Localised <span class=\"customMeta\" data-dictid=\"68186a21531692777194663901ae59\">osteolysis</span> with flame-shaped lesions and stress fractures.</li>\n<li><strong>Later stage</strong>: Thickened, <span class=\"customMeta\" data-dictid=\"934e9f88af169277719847f1a0728f\">sclerotic</span> bone with <span class=\"customMeta\" data-dictid=\"28606fa66a169277718407469e7e7c\">coarse</span> trabeculation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Bone <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">Biopsy</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rarely needed; used for <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> diagnosis to visualise the <span class=\"customMeta\" data-dictid=\"50c786f6e01692777192426797d791\">mosaic</span> pattern in bones.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radionucleotide Bone Scans </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Shows extensive <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> in affected bones.</li>\n<li>Differentiates PDB from bone <span class=\"customMeta\" data-dictid=\"ee33485c641692777192b16b999489\">metastases</span> (focal uptake).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medication</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Intravenous <span class=\"customMeta\" data-dictid=\"27920b5def1692777202f57479a0d4\">Zoledronate</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>First-line treatment; 4-5 mg infusion. <strong>(Option B)</strong></li>\n<li>Suppresses <span class=\"customMeta\" data-dictid=\"fc8c28347a16927771945680bd00be\">osteoclastic</span> activity; normalises <span class=\"customMeta\" data-dictid=\"4228218c971692777181ed18105c0d\">ALP</span> levels and relieves pain.</li>\n<li>Well-tolerated; flu-like symptoms may occur post-infusion.</li>\n<li><strong>Contraindicated</strong> in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> (eGFR &lt; 30 mL/min).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgery</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Fractures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> for long bone fractures; may correct deformities, but it is not the first-line treatment. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Osteoarthritis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Total <span class=\"customMeta\" data-dictid=\"ce5dcbe20f1692777190850ebec64c\">joint replacement</span> for severe cases, particularly in the hip or knee. <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Nerve Compression/Spinal Stenosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical <span class=\"customMeta\" data-dictid=\"46a5e63f281692777185d3f56ea186\">decompression</span> to relieve symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pre-operative Zoledronate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recommended to minimise <span class=\"customMeta\" data-dictid=\"a489e669011692777190af3dd98ed4\">intraoperative</span> <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> during surgery.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/UMyjeH99ubqMne31bCEc1744095998.mp3", "video": ""}, {"text": "A 68 year old man complains of persistent bone pain in his right leg and difficulty walking. He also reports that his leg has become visibly bowed over the past few years. Physical examination reveals a thickened and bowed right tibia. Laboratory tests show elevated serum alkaline phosphatase (ALP) with normal calcium and phosphate levels. X-ray of the tibia: Which of the following is the sign in the lesion above?", "options": [{"label": "A", "text": "Flame-shaped lucency", "correct": true}, {"label": "B", "text": "Looser zones", "correct": false}, {"label": "C", "text": "Sunburst pattern", "correct": false}, {"label": "D", "text": "Ground-glass appearance", "correct": false}], "correct_answer": "A. Flame-shaped lucency", "question_images": ["https://image.prepladder.com/content/8ZWhl9RGrpKycP6GD8wD1738035897.png"], "explanation_images": ["https://image.prepladder.com/content/1y0KS8hZFl86Y04OXL1L1738035156.png", "https://image.prepladder.com/content/aGEcHqc5Z0dHzl5ENRTW1738036161.png", "https://image.prepladder.com/content/NR6bXpNtPD3exxsKIEqg1738036027.png", "https://image.prepladder.com/content/9lpIBpMrSl2Eq2kVZysI1738036081.png", "https://image.prepladder.com/content/UxQIh3XewLzjdPSbolzw1738036127.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disease Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Early (osteolytic) phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Localised <span class=\"customMeta\" data-dictid=\"17d9369c3f1692777183b01f1dc72f\">bone resorption</span> often appears as \"flame-shaped\" lesions along the bone shaft. <strong>(Option C)</strong></li>\n<li>The skull may show <span class=\"customMeta\" data-dictid=\"4c8be6d6b716927771948551f98378\">osteoporosis</span> circumscripta (well-defined areas of bone loss).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Later stages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bone thickening and <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> with <span class=\"customMeta\" data-dictid=\"28606fa66a169277718407469e7e7c\">coarse</span> trabecular patterns.</li>\n<li>Stress fractures are visible as fine cracks on the <span class=\"customMeta\" data-dictid=\"00ab88c6091692777185ea2685fa40\">convex</span> surface of long bones.</li>\n<li>Pathological fractures may be present.”</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/0F5Jp2L7s50j29cDBhMS1744095541.mp3", "video": ""}, {"text": "A 70 year old male presents with increasing bone pain in his right pelvis and lower back. O/E, he has a noticeable enlargement of his skull, and his gait appears stiff. Laboratory investigations reveal elevated serum alkaline phosphatase (ALP) with normal calcium and phosphate levels. X-ray of the pelvis shows cortical thickening and bone enlargement. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Osteomalacia", "correct": false}, {"label": "B", "text": "Paget's disease of bone", "correct": true}, {"label": "C", "text": "Osteoporosis", "correct": false}, {"label": "D", "text": "Multiple myeloma", "correct": false}], "correct_answer": "B. Paget's disease of bone", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/8KDUfLDFkhbjGzgwy4f31738034699.png", "https://image.prepladder.com/content/ftUHXFwdE2wiBshx8TKV1738034792.png", "https://image.prepladder.com/content/TkaKDI1YRsRDdy0TBFAc1738034854.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Monostotic PDB</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Affects a single bone. <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">Serum</span> <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> <span class=\"customMeta\" data-dictid=\"65f1c4f3d4169277719505249503e0\">phosphatase</span> (ALP) may be normal.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Polyostotic PDB</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Affects multiple bones, more common than in <span class=\"customMeta\" data-dictid=\"bb410fd852169277719274df3a296f\">monostotic</span> fo” rm. The most common bones involved are: the pelvis, tibia&gt;femur, skull, spine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Familial PDB</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Affects 15-30% of cases, with 30% <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to <strong>SQTM1 gene </strong>mutations.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Severe, Early-Onset PDB </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> caused by mutations in the <span class=\"customMeta\" data-dictid=\"cebebc510416927771979a104a1d7b\">RANKL</span> gene.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/av502nkOxJdhamvFWhNq1744095004.mp3", "video": ""}, {"text": "A 4-year-old child is brought to the clinic with pain in the legs and swollen gums. The mother reports increased irritability and difficulty walking. Upon examination, there is subcutaneous bruising and tenderness in the lower limbs. You suspect a vitamin deficiency and order X-rays. What X-ray findings would you expect in this child?", "options": [{"label": "A", "text": "Normal bone structure", "correct": false}, {"label": "B", "text": "Dense lines between epiphysis and metaphysis, and a ground glass appearance", "correct": true}, {"label": "C", "text": "Widened epiphyseal plates and cupping of the metaphysis", "correct": false}, {"label": "D", "text": "Increased bone density with no fractures", "correct": false}], "correct_answer": "B. Dense lines between epiphysis and metaphysis, and a ground glass appearance", "question_images": ["https://image.prepladder.com/content/lkZdIXdKkBK6hkExRcZE1738033195.png"], "explanation_images": ["https://image.prepladder.com/content/37XWKdUR5tRz9D2Gv2Kx1738033271.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/rHc1zTHvzbFbIh6gqrwr1744094749.mp3", "video": ""}, {"text": "A 3 year old child is referred to a paediatrician due to poor growth and leg deformities. The mother mentions delays in walking and a noticeable protruding abdomen. On examination, bowing of the legs and tenderness around the wrists are observed. An X-ray of the lower limb of the child is given below. What other radiological findings would you expect to see in this child?", "options": [{"label": "A", "text": "Normal epiphyseal plate width, smooth metaphyseal lines, and no signs of bone deformities diaphyseal cortex", "correct": false}, {"label": "B", "text": "Delayed appearance of epiphyses, widening of epiphyseal plates, and rarefaction of the diaphyseal cortex", "correct": true}, {"label": "C", "text": "Cupping of the metaphysis, narrowing of the growth plate, and presence of subperiosteal erosions", "correct": false}, {"label": "D", "text": "Thickening of the diaphyseal cortex, normal bone structure, and no visible abnormalities", "correct": false}], "correct_answer": "B. Delayed appearance of epiphyses, widening of epiphyseal plates, and rarefaction of the diaphyseal cortex", "question_images": ["https://image.prepladder.com/content/zMIcmaDm1JIKihn3ZjoO1738032895.png"], "explanation_images": ["https://image.prepladder.com/content/ojFZWdebW4PgNclctCur1738032991.png", "https://image.prepladder.com/content/IFO12HnAJ6CvEZQztplX1738033047.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/1s9RcNAH9PwgFoGkp70w1744094504.mp3", "video": ""}, {"text": "Which of the following features are associated with rickets? Craniotabes Scorbutic rosary Bossing of the skull Harrison’s sulcus Perifollicular hemorrhage Brown's tumour Widening of wrists", "options": [{"label": "A", "text": "1 and 2 only", "correct": false}, {"label": "B", "text": "1, 3, 4, 7", "correct": true}, {"label": "C", "text": "2, 3, 4, 5", "correct": false}, {"label": "D", "text": "3, 4, 6", "correct": false}], "correct_answer": "B. 1, 3, 4, 7", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/tGdqJbSnJLS0OFh0ipxP1737778414.png", "https://image.prepladder.com/content/NMm63WfY8EM0FqDAU9P61737778521.png", "https://image.prepladder.com/content/AUgBchDtsdBKAa7SuYD31737778589.png", "https://image.prepladder.com/content/LDmij40qapXJDhkUm9ru1737778685.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/jfVNZnaepRNbgYGqNWWF1744094045.mp3", "video": ""}, {"text": "Which of the following is regarded as the best measurement of overall vitamin D status in the body?", "options": [{"label": "A", "text": "Calcitonin", "correct": false}, {"label": "B", "text": "Calcidiol", "correct": true}, {"label": "C", "text": "Ergocalciferol", "correct": false}, {"label": "D", "text": "Cholecalciferol", "correct": false}], "correct_answer": "B. Calcidiol", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/6u6O3duLxQqVgiZjDzFP1737777873.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/elnoG2BmScra36VPOy7E1744093930.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 42 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 14</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Metabolic Bone Diseases-Previous Year Questions - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 14</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 14 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "FRAX is", "options": [{"label": "A", "text": "Fracture Risk assessment tool", "correct": true}, {"label": "B", "text": "Fracture Rehabilitation assessment tool", "correct": false}, {"label": "C", "text": "Fracture Reducibility assessment tool", "correct": false}, {"label": "D", "text": "Fracture Rehabilitation assessment tool", "correct": false}], "correct_answer": "A. Fracture Risk assessment tool", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7-year-old child was brought with bow legs and on x-ray of wrist following were the findings. What is the diagnosis?", "options": [{"label": "A", "text": "Rickets", "correct": true}, {"label": "B", "text": "Scurvy", "correct": false}, {"label": "C", "text": "Hypophosphatemia", "correct": false}, {"label": "D", "text": "None", "correct": false}], "correct_answer": "A. Rickets", "question_images": ["https://image.prepladder.com/content/ksKq0CUKsCVSvOnb1UvF1741087161.png"], "explanation_images": ["https://image.prepladder.com/content/MaeIdjipQgcgxAZyLGfV1741060320.png", "https://image.prepladder.com/content/s0fCIVY3wfk6V83OBIM21741060343.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with growth failure. Biochemical analysis shows normal ca2+, normal PTH, reduced phosphate, and increased ALP. What is the diagnosis?", "options": [{"label": "A", "text": "Nutritional rickets", "correct": false}, {"label": "B", "text": "Hypophosphatemic rickets", "correct": true}, {"label": "C", "text": "Type 1 VDDR", "correct": false}, {"label": "D", "text": "Type 2 VDDR", "correct": false}], "correct_answer": "B. Hypophosphatemic rickets", "question_images": ["https://image.prepladder.com/content/3gmzZKRy4mF5B4X5Nhho1724756905.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old female complains of bone pain for several months. His X-ray skull is given below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Osteosarcoma", "correct": false}, {"label": "B", "text": "Osteochondroma", "correct": false}, {"label": "C", "text": "Paget’s disease", "correct": true}, {"label": "D", "text": "Ewing’s sarcoma", "correct": false}], "correct_answer": "C. Paget’s disease", "question_images": ["https://image.prepladder.com/content/UOibfx5n2jierhCHm6Ge1747288440.png"], "explanation_images": ["https://image.prepladder.com/notes/wl9gEfdaj9qbzbcGxCYa1747659395.png", "https://image.prepladder.com/content/swMvgBb1k4F4DDvW5VvK1747288501.png", "https://image.prepladder.com/content/V24LsM8C28oI9P9YOUoe1747288501.png", "https://image.prepladder.com/content/g8hm6KgfYtw4zI2ss1kP1747288501.png", "https://image.prepladder.com/content/IWvjMSbky9Dh6gGkvaV41747288501.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Disease Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>X-ray Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Early (osteolytic) phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Localised <span class=\"customMeta\" data-dictid=\"17d9369c3f1692777183b01f1dc72f\">bone resorption</span> often appears as \"flame-shaped\" lesions along the bone shaft. <strong>(Option C)</strong></li>\n<li>The skull may show <span class=\"customMeta\" data-dictid=\"4c8be6d6b716927771948551f98378\">osteoporosis</span> circumscripta (well-defined areas of bone loss).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Later stages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bone thickening and <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> with <span class=\"customMeta\" data-dictid=\"28606fa66a169277718407469e7e7c\">coarse</span> trabecular patterns.</li>\n<li>Stress fractures are visible as fine cracks on the <span class=\"customMeta\" data-dictid=\"00ab88c6091692777185ea2685fa40\">convex</span> surface of long bones.</li>\n<li>Pathological fractures may be present.”</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following vitamin deficiencies is seen in rickets?", "options": [{"label": "A", "text": "Vitamin A", "correct": false}, {"label": "B", "text": "Vitamin B", "correct": false}, {"label": "C", "text": "Vitamin C", "correct": false}, {"label": "D", "text": "Vitamin D", "correct": true}], "correct_answer": "D. Vitamin D", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:592px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Calcipenic Rickets</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Inadequate <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> <strong>(often vitamin D deficiency)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Calcium Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Low <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> leads to hypocalcemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Phosphate Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Hypophosphatemia due to a decrease in <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> resorption.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Pathophysiological Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Activation of the parathyroid–bone <span class=\"customMeta\" data-dictid=\"3c28fd47f71692777182efbbaa5f6d\">axis</span> for <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> preservation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Associated Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Primarily <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to vitamin D deficiency</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Effect on Growth Plate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Reduced <span class=\"customMeta\" data-dictid=\"4bfa3e6f2c1692777181c53b124cf7\">apoptosis</span> of hypertrophic chondrocytes due to hypophosphatemia</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What treatment would you provide to a 60-year-old female patient who had a Colles' fracture 8 months ago, has a T score of -2.5, attained menopause at 52 years, and is currently not experiencing any symptoms, when she visits the orthopedics outpatient department?", "options": [{"label": "A", "text": "Hormone replacement therapy", "correct": false}, {"label": "B", "text": "Alendronate", "correct": true}, {"label": "C", "text": "Calcium and vitamin D", "correct": false}, {"label": "D", "text": "Repeat DEXA scan after 3 months", "correct": false}], "correct_answer": "B. Alendronate", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:633px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pharmacological Agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of Action</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bisphosphonates (Alendronate, Risedronate, Ibandronate) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Interfere with <span class=\"customMeta\" data-dictid=\"c21bdae5e116927771947204c2076c\">osteoclast</span> activity, leading to decreased bone resorption.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Calcitonin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inhibits <span class=\"customMeta\" data-dictid=\"c21bdae5e116927771947204c2076c\">osteoclast</span> activity, reducing bone resorption.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Denosumab</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It inhibits the RANK ligand, essential for <span class=\"customMeta\" data-dictid=\"c21bdae5e116927771947204c2076c\">osteoclast</span> formation and function.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Estrogen/Raloxifene</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inhibit <span class=\"customMeta\" data-dictid=\"c21bdae5e116927771947204c2076c\">osteoclast</span> activity and slow bone loss.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cinacalcet</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Indirectly reduces <span class=\"customMeta\" data-dictid=\"17d9369c3f1692777183b01f1dc72f\">bone resorption</span> by <span class=\"customMeta\" data-dictid=\"ff02aa40d51692777191246d4a9b87\">lowering</span> <span class=\"customMeta\" data-dictid=\"5eff25235516927771968c590529d7\">PTH</span> levels.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Teriparatide</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"b566321fe8169277719716b1cf4df0\">recombinant</span> <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of <span class=\"customMeta\" data-dictid=\"5eff25235516927771968c590529d7\">PTH</span> stimulates <span class=\"customMeta\" data-dictid=\"8e55f8d71d1692777194a10c3d3d9d\">osteoblast</span> activity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Strontium Ranelate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dual action:</strong> It promotes bone formation by stimulating osteoblasts and decreases <span class=\"customMeta\" data-dictid=\"17d9369c3f1692777183b01f1dc72f\">bone resorption</span> by inhibiting <span class=\"customMeta\" data-dictid=\"c21bdae5e116927771947204c2076c\">osteoclast</span> activity.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is a characteristic feature observed in osteoporosis?", "options": [{"label": "A", "text": "Normal calcium and increased ALP", "correct": false}, {"label": "B", "text": "Normal calcium and normal ALP", "correct": true}, {"label": "C", "text": "Decreased calcium and normal ALP", "correct": false}, {"label": "D", "text": "Increased calcium and increased ALP", "correct": false}], "correct_answer": "B. Normal calcium and normal ALP", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 5-year-old child who visited the pediatrician due to bilateral knee joint pain, normal bone mineral density, and the provided X-ray image of the joints?", "options": [{"label": "A", "text": "Scurvy", "correct": true}, {"label": "B", "text": "Rickets", "correct": false}, {"label": "C", "text": "Metaphyseal dysplasia", "correct": false}, {"label": "D", "text": "Pycnodysostosis", "correct": false}], "correct_answer": "A. Scurvy", "question_images": ["https://image.prepladder.com/content/B7C2143MoaQtKnlJWtR61745392381.png"], "explanation_images": ["https://image.prepladder.com/notes/MkMHu69rTgXSnZolqExr1746427969.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Diagnosis of Gout is confirmed by which test?", "options": [{"label": "A", "text": "Serum uric acid level", "correct": false}, {"label": "B", "text": "Synovial fluid analysis", "correct": true}, {"label": "C", "text": "Urine uric acid levels", "correct": false}, {"label": "D", "text": "X-ray changes", "correct": false}], "correct_answer": "B. Synovial fluid analysis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which tumor does not cause osteomalacia and phosphaturia?", "options": [{"label": "A", "text": "Osteosarcoma", "correct": false}, {"label": "B", "text": "Hemangiopericytoma", "correct": false}, {"label": "C", "text": "Fibrosarcoma", "correct": false}, {"label": "D", "text": "Breast carcinoma", "correct": true}], "correct_answer": "D. Breast carcinoma", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely cause of the noted findings in a 39-year-old male who presents to the clinic for a routine checkup and only exhibits mild generalized weakness without any other symptoms? Parameters Values ALP Normal Calcium High Phosphate High PTH Normal", "options": [{"label": "A", "text": "Vitamin D toxicity", "correct": true}, {"label": "B", "text": "Hyperparathyroidism", "correct": false}, {"label": "C", "text": "Osteoporosis", "correct": false}, {"label": "D", "text": "Osteomalacia", "correct": false}], "correct_answer": "A. Vitamin D toxicity", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Vitamin D T\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Aspect</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Vitamin D Toxicity</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Hyperparathyroidism</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Cause</p>\n</td>\n<td>\n<p>Excessive <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> or production of Vitamin D</p>\n</td>\n<td>\n<p>Overactivity or <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> of <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> glands</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vitamin D Levels</p>\n</td>\n<td>\n<p>Elevated</p>\n</td>\n<td>\n<p>Normal or decreased (primary) / variable (secondary)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Parathyroid Hormone (PTH) Levels</p>\n</td>\n<td>\n<p>Normal or suppressed</p>\n</td>\n<td>\n<p>Increased</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Calcium Levels</p>\n</td>\n<td>\n<p>Elevated (hypercalcemia)</p>\n</td>\n<td>\n<p>Increased (primary) / Normal or slightly increased (secondary)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Phosphate Levels</p>\n</td>\n<td>\n<p>Elevated (hyperphosphatemia)</p>\n</td>\n<td>\n<p>Normal or decreased</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Clinical Features</p>\n</td>\n<td>\n<p>Generalized weakness, fatigue, nausea, vomiting, constipation, confusion, excessive thirst, frequent urination</p>\n</td>\n<td>\n<p>Fatigue, weakness, bone pain, <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> stones, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> discomfort, psychiatric symptoms</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Treatment</p>\n</td>\n<td>\n<p>Discontinue excessive <span class=\"customMeta\" data-dictid=\"77a4f731501692777202a03bfca9b4\">Vitamin D</span> intake, supportive care, monitor and manage <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> levels</p>\n</td>\n<td>\n<p>Surgical removal of <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> gland(s) (primary), treat underlying condition and optimize <span class=\"customMeta\" data-dictid=\"77a4f731501692777202a03bfca9b4\">vitamin D</span> and <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> levels (secondary)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60 year old woman presents with low backache and on a lumbar CT the following is seen. What is your diagnosis?", "options": [{"label": "A", "text": "Spondylolisthesis", "correct": false}, {"label": "B", "text": "Discitis", "correct": false}, {"label": "C", "text": "Osteoporosis", "correct": true}, {"label": "D", "text": "Pott's spine", "correct": false}], "correct_answer": "C. Osteoporosis", "question_images": ["https://image.prepladder.com/content/0MiBslpGUmONR8n0Edh71691507116.png"], "explanation_images": [], "explanation": "<p>Correct Option C - O\n<p><strong>References:</strong></p>\n<ul><li>↳ individual's BMD and the average BMD of the young</li><li>↳ healthy reference populatio</li><li>↳ T-Score Bone Density Status &gt; -1.0 Normal -1.0 to -2.5 Osteopenia (Low bone density) &lt; -2.5 Osteoporosis &lt; -2.5 with fragility fracture Severe Osteoporosis</li><li>↳ T-Score Bone Density Status</li><li>↳ T-Score</li><li>↳ T-Score</li><li>↳ T-Score</li><li>↳ Bone Density Status</li><li>↳ Bone Density Status</li><li>↳ Bone Density Status</li><li>↳ &gt; -1.0 Normal</li><li>↳ &gt; -1.0</li><li>↳ &gt; -1.0</li><li>↳ Normal</li><li>↳ Normal</li><li>↳ -1.0 to -2.5 Osteopenia (Low bone density)</li><li>↳ -1.0 to -2.5</li><li>↳ -1.0 to -2.5</li><li>↳ Osteopenia (Low bone density)</li><li>↳ Osteopenia (Low bone density)</li><li>↳ &lt; -2.5 Osteoporosis</li><li>↳ &lt; -2.5</li><li>↳ &lt; -2.5</li><li>↳ Osteoporosis</li><li>↳ Osteoporosis</li><li>↳ &lt; -2.5 with fragility fracture Severe Osteoporosis</li><li>↳ &lt; -2.5 with fragility fracture</li><li>↳ &lt; -2.5 with fragility fracture</li><li>↳ Severe Osteoporosis</li><li>↳ Severe Osteoporosis</li></ul>\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>T-Score</strong></p>\n</td>\n<td>\n<p><strong>Bone Density Status</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>&gt; -1.0</p>\n</td>\n<td>\n<p>Normal</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>-1.0 to -2.5</p>\n</td>\n<td>\n<p>Osteopenia (Low bone density)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>&lt; -2.5</p>\n</td>\n<td>\n<p>Osteoporosis</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>&lt; -2.5 with <span class=\"customMeta\" data-dictid=\"0f4e78e9121692777203594ba840cc\">fragility</span> fracture</p>\n</td>\n<td>\n<p>Severe Osteoporosis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Albers Schonberg disease is:", "options": [{"label": "A", "text": "Paget", "correct": false}, {"label": "B", "text": "Osteogenesis imperfecta", "correct": false}, {"label": "C", "text": "Osteoporosis", "correct": false}, {"label": "D", "text": "Osteopetrosis", "correct": true}], "correct_answer": "D. Osteopetrosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - O\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 4-year-old child was brought to the OPD with a painless deformity . A radiograph of the child's legs is shown below. The most common cause of this deformity is____.", "options": [{"label": "A", "text": "Skeletal dysplasia", "correct": false}, {"label": "B", "text": "Rickets", "correct": true}, {"label": "C", "text": "Scurvy", "correct": false}, {"label": "D", "text": "Blount disease", "correct": false}], "correct_answer": "B. Rickets", "question_images": ["https://image.prepladder.com/content/Kvhz1o31odjSw6AWAFRt1691479474.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Rick\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 24 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 16</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Nerve Injuries-Peripheral Nerve Injuries - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 16</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 16 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Match the following components of a nerve with their corresponding structures: 1. Endoneurium a. Surrounds nerve 2. Perineurium b. Surrounds axons 3. Epineurium c. Surrounds fascicles", "options": [{"label": "A", "text": "1-b, 2-c, 3-a", "correct": true}, {"label": "B", "text": "1-a, 2-b, 3-c", "correct": false}, {"label": "C", "text": "1-c, 2-a, 3-b", "correct": false}, {"label": "D", "text": "1-b, 2-a, 3-c", "correct": false}], "correct_answer": "A. 1-b, 2-c, 3-a", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/5bm6N4Ks3x1lz1KDvevM1737796602.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:292px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.Endoneurium</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>b. Surrounds axons</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2. Perineurium</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>c. Surrounds fascicles</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3. Epineurium</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>a. Surrounds nerve</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Somatic nervous system</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Autonomic nervous system</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Voluntary control</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involuntary control</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Skeletal muscle innervation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Smooth muscle, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> muscle and glands</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>One <span class=\"customMeta\" data-dictid=\"17d10546871692777193f302d45980\">neuron</span> from <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> to effector(motor)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Preganglionic and <span class=\"customMeta\" data-dictid=\"28ec2061691692777196c06b1c0fd4\">Postganglionic</span> neurons</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Divided into <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> and motor nerve</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Divided into <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> and <span class=\"customMeta\" data-dictid=\"8f19a37b5916927771941ba9f5ef49\">parasympathetic</span> nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Controls voluntary movement of skeletal muscles.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regulates <span class=\"customMeta\" data-dictid=\"42b110efe11692777190ea5720c867\">involuntary</span> movements such as heart rate, and digestion.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/TqgeYWeddnkn8fFq9z7H1743492627.mp3", "video": ""}, {"text": "What is the approximate rate of axon regeneration in the peripheral nervous system (PNS)?", "options": [{"label": "A", "text": "10 mm per day", "correct": false}, {"label": "B", "text": "5 mm per day", "correct": false}, {"label": "C", "text": "1 mm per day", "correct": true}, {"label": "D", "text": "0.1 mm per day", "correct": false}], "correct_answer": "C. 1 mm per day", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vcB5kzmp2TwGRj7kGFG21737796723.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:507px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fractures and dislocations</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most common cause</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uncontrolled diabetes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>2nd Most common cause</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Direct injury</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cut, laceration</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mechanical injury</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Compression</strong></p>\n<ul>\n<li>Radial nerve - Saturday night palsy</li>\n<li>Axillary nerve - <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">Dislocation</span> of the shoulder</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Traction</strong></p>\n<ul>\n<li>Birth injury- Erb’s palsy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ischaemic injury</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Volkmann’s ischaemia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Toxic agents</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inj. <span class=\"customMeta\" data-dictid=\"8784b5a7ad16927772005323b514b8\">Tetracycline</span> results in <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> nerve palsy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radiation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>For cancer treatment</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/mV6IwIRfoAo4o1qUVBZP1743492903.mp3", "video": ""}, {"text": "Which of the following best describes the pathology of neuropraxia?", "options": [{"label": "A", "text": "Complete interruption of both axons and surrounding structures", "correct": false}, {"label": "B", "text": "Disruption of the myelin sheath with preserved axon integrity", "correct": true}, {"label": "C", "text": "Degeneration of the axon with intact surrounding connective tissue", "correct": false}, {"label": "D", "text": "Loss of the entire nerve, including the surrounding connective tissues", "correct": false}], "correct_answer": "B. Disruption of the myelin sheath with preserved axon integrity", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/mrIh2JWiZods8TJZtp0T1737796804.png", "https://image.prepladder.com/content/Lya5KF8fF1g2YCSMAmCt1737796858.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:568px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Prognosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neurapraxia</p>\n<p>(Grade I)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Temporary <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> block, <span class=\"customMeta\" data-dictid=\"47fec911a316927771933b7607bdf0\">myelin</span> damage only.</li>\n<li>No <span class=\"customMeta\" data-dictid=\"11117a474a1692777193044082d47a\">neuroma</span> and no degeneration.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recovery is complete within 6 weeks.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Axonotmesis</p>\n<p>(Grade II)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Axonal damage, <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue intact.</li>\n<li>Neuroma in continuity.</li>\n<li>Degeneration: Proximally+distally.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recovery can take up to months</li>\n<li>Complete recovery may not occur.</li>\n<li>Motor march present</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neurotmesis</p>\n<p>(Grade III)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Complete nerve disruption.</li>\n<li>End or side neuroma.</li>\n<li>Degeneration: Proximally+distally.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Spontaneous recovery never occurs.</li>\n<li>Repair is required (poor recovery)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Physiological <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> of <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> in nerve <span class=\"customMeta\" data-dictid=\"3ace01719a1692777202ddafcebbc4\">fibre</span> with temporary loss of motor and <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> function without any structural damage to the nerve.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"STATPEARLS\" data-hash=\"\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.ncbi.nlm.nih.gov/books/NBK557746/figure/article-25766.image.f2/\" data-tags=\"\" height=\"3290\" src=\"https://image.prepladder.com/content/Lya5KF8fF1g2YCSMAmCt1737796858.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cause</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Commonly caused by compression, stretching, or <span class=\"customMeta\" data-dictid=\"324b1bfa7816927771834f9e3f6704\">blunt</span> trauma to a nerve, often seen in sports injuries, falls, or prolonged pressure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mechanism</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> of the <span class=\"customMeta\" data-dictid=\"47fec911a316927771933b7607bdf0\">myelin</span> <span class=\"customMeta\" data-dictid=\"44e9c0bbec169277719829907370ee\">sheath</span> surrounding the nerve fibers, which leads to a temporary <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> block while preserving the axon’s structure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Temporary numbness, weakness, or <span class=\"customMeta\" data-dictid=\"b7020a23961692777200b1237ae429\">tingling</span> in the affected area.</p>\n<p>Decreased reflexes and muscle strength, but usually not complete paralysis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Based on clinical examination and patient history; electrodiagnostic tests (e.g., nerve <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> studies) may confirm the diagnosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Classification</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Classified as a first-degree nerve injury, indicating the least severe type of nerve injury.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prognosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically good, with recovery occurring within 6 weeks.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generally conservative; may include rest, physical therapy, and avoiding activities that could further irritate the nerve.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/J2VRiFfV5mmmHMI66nek1743493509.mp3", "video": ""}, {"text": "Which of the following is true regarding axonotmesis?", "options": [{"label": "A", "text": "Spontaneous recovery occurs within days or weeks", "correct": false}, {"label": "B", "text": "Complete nerve disruption occurs", "correct": false}, {"label": "C", "text": "Loss of conduction within an intact neural tube", "correct": true}, {"label": "D", "text": "Occurs due to segmental demyelination by mechanical pressure", "correct": false}], "correct_answer": "C. Loss of conduction within an intact neural tube", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/p9DKDAoZEjWr86k3fKGZ1737796996.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:611px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Prognosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neurapraxia</p>\n<p>(Grade I)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Temporary <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> block, <span class=\"customMeta\" data-dictid=\"47fec911a316927771933b7607bdf0\">myelin</span> damage only.</li>\n<li>Segmental <span class=\"customMeta\" data-dictid=\"336cefd9041692777185a8959344f8\">demyelination</span> due to mechanical pressure <strong>(Option D)</strong></li>\n<li>No <span class=\"customMeta\" data-dictid=\"11117a474a1692777193044082d47a\">neuroma</span> and no degeneration.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recovery is complete within days or weeks <strong>(Option A)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Axonotmesis</p>\n<p>(Grade II)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Axonal damage, <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue intact.</li>\n<li>Loss of <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> within an intact <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">neural</span> tube - <span class=\"customMeta\" data-dictid=\"11117a474a1692777193044082d47a\">Neuroma</span> in <span class=\"customMeta\" data-dictid=\"17e718612e1692777185f79acb759b\">continuity</span> <strong>(Option C)</strong></li>\n<li>Degeneration: Proximally+distally.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Recovery may occur spontaneously or take many months.</strong></li>\n<li><strong>Complete recovery may not occur.</strong></li>\n<li><strong>Motor march </strong>(nerve re-innervates muscles from <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> to distal) present</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neurotmesis</p>\n<p>(Grade III)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Complete nerve <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> <strong>(Option B)</strong></li>\n<li>End or side neuroma.</li>\n<li>Degeneration: Proximally+distally.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Spontaneous recovery never occurs.</li>\n<li>Repair is required (poor recovery)</li>\n<li>Function maybe adequate but never complete</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Axonal Damage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"93cb75311c16927771828ed307dcc0\">axon</span> is disrupted, causing <span class=\"customMeta\" data-dictid=\"54dcaa4c1616927772021796ebe812\">Wallerian</span> <span class=\"customMeta\" data-dictid=\"df4f1758e2169277718697ae66f3dd\">degeneration</span> <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> to the site of injury.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intact <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">Connective</span> Tissues </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"d55670497f1692777187a366e73cce\">epineurium</span> and <span class=\"customMeta\" data-dictid=\"d7401663701692777195b99f59673a\">perineurium</span> remain intact, which facilitates axonal regrowth.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wallerian Degeneration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> to the injury, involving <span class=\"customMeta\" data-dictid=\"df4f1758e2169277718697ae66f3dd\">degeneration</span> of the <span class=\"customMeta\" data-dictid=\"93cb75311c16927771828ed307dcc0\">axon</span> and <span class=\"customMeta\" data-dictid=\"47fec911a316927771933b7607bdf0\">myelin</span> sheath.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Regeneration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The nerve has the potential to regenerate because the <span class=\"customMeta\" data-dictid=\"3aa5abc2fa169277719488e088076d\">pathway</span> for axonal growth is preserved, typically at a rate of 1-3 mm per day.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Crush Injuries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>This is a common mechanism leading to axonotmesis, where the nerve is compressed or crushed, causing axonal damage.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Motor and <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">Sensory</span> Deficits</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Loss of motor function and sensation <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> to the injury.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Absent Reflexes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reflexes in the affected region are typically absent.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conservative Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In most cases, <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention is not necessary. Recovery occurs as the <span class=\"customMeta\" data-dictid=\"93cb75311c16927771828ed307dcc0\">axon</span> regenerates.</p>\n<p>Physical therapy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Good <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> for recovery since the structural framework of the nerve is preserved, allowing for regrowth and reconnection of the nerve fibers.</p>\n<p>Recovery can take weeks to months.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/YsBtnaMEgoLXbg302saC1743494415.mp3", "video": ""}, {"text": "A 32-year-old man sustains a deep laceration to his forearm from a sharp object. On examination, he has complete loss of motor function and sensation in the hand, and reflexes are absent. Despite immobilization and physical therapy, no improvement is noted after several weeks. Which type of nerve injury has most likely occurred?", "options": [{"label": "A", "text": "Neurapraxia", "correct": false}, {"label": "B", "text": "Axonotmesis", "correct": false}, {"label": "C", "text": "Neurotmesis", "correct": true}, {"label": "D", "text": "Radiculopathy", "correct": false}], "correct_answer": "C. Neurotmesis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Eegrwc91K1mxUf4GVW0p1737797088.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:568px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Prognosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neurapraxia</p>\n<p>(Grade I)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Temporary <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> block, <span class=\"customMeta\" data-dictid=\"47fec911a316927771933b7607bdf0\">myelin</span> damage only.</li>\n<li>No <span class=\"customMeta\" data-dictid=\"11117a474a1692777193044082d47a\">neuroma</span> and no degeneration.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recovery is complete within 6 weeks.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Axonotmesis</p>\n<p>(Grade II)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Axonal damage, <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue intact.</li>\n<li>Neuroma in continuity.</li>\n<li>Degeneration: Proximally+distally.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recovery may occur spontaneously or take many months.</li>\n<li>Complete recovery may not occur</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neurotmesis</p>\n<p>(Grade III)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Complete nerve disruption.</li>\n<li>End or side neuroma.</li>\n<li>Degeneration: Proximally+distally.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Complete recovery never occurs</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Complete Disruption: </strong>Both the <span class=\"customMeta\" data-dictid=\"93cb75311c16927771828ed307dcc0\">axon</span> and the nerve's supportive structures are completely severed.</li>\n<li><strong>Loss of Function:</strong> This leads to total loss of motor and <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> function in the region supplied by the affected nerve.</li>\n<li><strong>Wallerian Degeneration:</strong> The portion of the <span class=\"customMeta\" data-dictid=\"93cb75311c16927771828ed307dcc0\">axon</span> <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> to the injury undergoes <span class=\"customMeta\" data-dictid=\"54dcaa4c1616927772021796ebe812\">Wallerian</span> degeneration, where the <span class=\"customMeta\" data-dictid=\"93cb75311c16927771828ed307dcc0\">axon</span> and <span class=\"customMeta\" data-dictid=\"47fec911a316927771933b7607bdf0\">myelin</span> <span class=\"customMeta\" data-dictid=\"44e9c0bbec169277719829907370ee\">sheath</span> break down.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Severe Trauma:</strong> <span class=\"customMeta\" data-dictid=\"55b31d659b16927771958a15837b10\">Penetrating</span> injuries such as cuts, gunshot wounds, or severe crush injuries are common causes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Complete Motor and <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">Sensory</span> Loss: </strong>There is no movement or sensation <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> to the injury. Reflexes in the affected area are absent.</li>\n<li><strong>No <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">Spontaneous</span> Recovery:</strong> Unlike less severe nerve injuries, <span class=\"customMeta\" data-dictid=\"05ae605eb81692777193359fdca623\">neurotmesis</span> does not allow for <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> recovery because the nerve's structural <span class=\"customMeta\" data-dictid=\"17e718612e1692777185f79acb759b\">continuity</span> is disrupted.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Clinical Examination</li>\n<li>Electromyography (EMG) and Nerve <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">Conduction</span> Studies (NCS)</li>\n<li>MRI or ultrasound</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Surgical Repair:</strong> Nerve ends are surgically reconnected, or <strong>nerve <span class=\"customMeta\" data-dictid=\"6ca773c032169277718858b8ad1e9c\">grafting</span> </strong>is performed to bridge the gap between the severed ends. <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">Tendon</span> transfer procedures are also done.</li>\n<li><strong>Physical Therapy:</strong> Post-surgical therapy is crucial to maintain muscle tone and promote recovery once the nerve starts regenerating.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Without <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> Repair: </strong></p>\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> is poor, with no chance of functional recovery.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>With <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> Repair:</strong></p>\n<ul>\n<li>Recovery depends on the extent of the injury, the length of time between injury and surgery, and the success of the repair.</li>\n</ul>\n<ul>\n<li>Even with surgery, full recovery may not be possible, especially in cases of long nerve gaps or severe trauma.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/mu47nSHfnDm4gDPNzS2Z1743507216.mp3", "video": ""}, {"text": "Focal segmental demyelination of a nerve is classified under Neurapraxia in the Seddon classification. What is the grade of the nerve injury according to the Sunderland classification?", "options": [{"label": "A", "text": "Grade I", "correct": true}, {"label": "B", "text": "Grade II", "correct": false}, {"label": "C", "text": "Grade III", "correct": false}, {"label": "D", "text": "Grade IV", "correct": false}], "correct_answer": "A. Grade I", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/apJOA6c3EGwvFUkVDAMP1744257857.png", "https://image.prepladder.com/content/BCAAL7tJfcKGlTacX1Mo1737797331.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:645px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Sunderland classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Seddon classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade I</strong></p>\n<p><strong>(Option A)</strong><strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurapraxia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Focal <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> demyelination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spontaneous Recovery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Grade II</p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Axonotmesis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Damaged <span class=\"customMeta\" data-dictid=\"93cb75311c16927771828ed307dcc0\">axon</span> with intact endoneurium</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spontaneous Recovery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Grade III</p>\n<p><strong>(Option C ruled out)</strong></p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Axonotmesis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Damaged <span class=\"customMeta\" data-dictid=\"93cb75311c16927771828ed307dcc0\">axon</span> and <span class=\"customMeta\" data-dictid=\"eeb84933a41692777187cba6c665dd\">endoneurium</span> with intact perineurium</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical intervention may be needed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">Grade IV <strong>(option D ruled out )</strong></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">Axonotmesis</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">Only the <span class=\"customMeta\" data-dictid=\"d55670497f1692777187a366e73cce\">epineurium</span> is intact. The nerve trunk is still in <span class=\"customMeta\" data-dictid=\"17e718612e1692777185f79acb759b\">continuity</span> but internal damage is severe</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> the injured segment should be excised and the nerve repaired or grafted</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">Grade V</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">Neurotemesis</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">The nerve is divided </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">Nerve repairment</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/IUjJ0I2qikzhwSWByAvb1743507450.mp3", "video": ""}, {"text": "Grade IV nerve injury according to Sunderland classification corresponds to which Seddon classification?", "options": [{"label": "A", "text": "Axonotmesis", "correct": true}, {"label": "B", "text": "Neurotmesis", "correct": false}, {"label": "C", "text": "Neurapraxia", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Axonotmesis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/op24ZSsIEublKCiVHCC41737797385.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Sunderland classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Seddon classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade IV </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Axonotmesis</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Damaged axon, endoneurium, and <span class=\"customMeta\" data-dictid=\"d7401663701692777195b99f59673a\">perineurium</span> with intact epineurium</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Grade V</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neurotmesis</p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complete nerve <span class=\"customMeta\" data-dictid=\"48ff530c761692777200c1afac0052\">transection</span> (disruption of <span class=\"customMeta\" data-dictid=\"47fec911a316927771933b7607bdf0\">myelin</span> sheath, axon, endoneurium, perineurium, and epineurium)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgery</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/it2BYV5XIItNtLbF6bHk1743507585.mp3", "video": ""}, {"text": "Which of the following best describes external neurolysis?", "options": [{"label": "A", "text": "Freeing nerve from surrounding", "correct": true}, {"label": "B", "text": "Dissecting nerve sheath", "correct": false}, {"label": "C", "text": "Altering course of nerve", "correct": false}, {"label": "D", "text": "Sacrificing unimportant nerve branches", "correct": false}], "correct_answer": "A. Freeing nerve from surrounding", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Conservative Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Required in all types of nerve injury</li>\n<li>Aimed at preserving limb <span class=\"customMeta\" data-dictid=\"650eb29fb9169277719270ea0fbea5\">mobility</span> during nerve recovery</li>\n<li>Types:</li>\n</ul>\n<ul>\n<li>Splintage of the Paralysed Limb</li>\n<li>Preserve Joint Mobility</li>\n<li>Skin and Nail Care</li>\n<li>Physiotherapy</li>\n<li>Pain Relief</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Operative Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nerve Suture</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Techniques include epineural, epi-perineural, perineural, and group <span class=\"customMeta\" data-dictid=\"ee875e7c3416927772026804e2e155\">fascicular</span> repair.</li>\n<li>Methods for achieving an end-to-end suture: Mobilization, joint positioning, nerve course alteration, <span class=\"customMeta\" data-dictid=\"85cb03377b1692777199d46846ce58\">stripping</span> branches, and sacrificing unimportant branches.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nerve Grafting</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>For gaps greater than 10 cm or when tension is likely at the <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> line.</li>\n<li>The sural nerve is used as a graft.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neurolysis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>External Neurolysis: Freeing nerve from surrounding <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> tissue. </strong><strong>(Option A) </strong></li>\n<li>Internal Neurolysis: Dissecting <span class=\"customMeta\" data-dictid=\"782b2a963516927771936bac7aff14\">nerve sheath</span> to relieve internal pressure. <strong>(Option B ruled out) </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reconstructive Surgery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>When there’s no hope of nerve recovery</li>\n<li>Usually after 18 months</li>\n<li>Types:\n\t\t\t\t<ul>\n<li>Tendon transfers</li>\n<li>Arthrodesis</li>\n<li>Muscle transfer</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/dJyxK7jT85myJLYGCJkS1743507670.mp3", "video": ""}, {"text": "What is the location at which the radial nerve is getting injured in a Saturday night palsy?", "options": [{"label": "A", "text": "Axilla", "correct": false}, {"label": "B", "text": "Shoulder", "correct": false}, {"label": "C", "text": "Elbow", "correct": false}, {"label": "D", "text": "Spiral groove", "correct": true}], "correct_answer": "D. Spiral groove", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/whRCUqQ5gNRTBwBJlLul1737797700.png", "https://image.prepladder.com/content/TQDJKsIuiaqGYpnIo0fb1737797790.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:602px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Causes of <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> nerve injury </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In the Axilla</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Aneurysm of the axillary vessels</li>\n<li>Crutch palsy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In the Shoulder</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Proximal humeral fractures</li>\n<li>Shoulder dislocation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>In the <span class=\"customMeta\" data-dictid=\"0b34a9891d16927771998a84595013\">Spiral</span> <span class=\"customMeta\" data-dictid=\"21ee3a5f911692777188099a3310c4\">Groove</span> </strong></p>\n<p><strong>(5 ‘S’)</strong></p>\n<p><strong>(Option D)</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/TQDJKsIuiaqGYpnIo0fb1737797790.png\" width=\"500\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Shaft fracture</li>\n<li><strong>Saturday night palsy</strong></li>\n<li>Syringe palsy</li>\n<li>Surgical positions (Trendelenburg)</li>\n<li>'S’march's (Esmarch) <span class=\"customMeta\" data-dictid=\"337361b1601692777200049d28078e\">tourniquet</span> palsy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Between <span class=\"customMeta\" data-dictid=\"0b34a9891d16927771998a84595013\">Spiral</span> <span class=\"customMeta\" data-dictid=\"21ee3a5f911692777188099a3310c4\">Groove</span> and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> Epicondyle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fracture <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> of humerus</li>\n<li>Supracondylar <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> humerus</li>\n<li>Lateral <span class=\"customMeta\" data-dictid=\"9cdc5a92a216927771870d4b257a80\">epicondyle</span> fracture</li>\n<li>Penetrating and gunshot injuries</li>\n<li>Cubitus <span class=\"customMeta\" data-dictid=\"e33d939e82169277720167f59b0ee2\">valgus</span> deformity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>At the Elbow</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Posterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of the elbow</li>\n<li>Fracture of the head of the radius</li>\n<li>Monteggia fractures</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In the Forearm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fracture of both bones in the forearm</li>\n<li>Penetrating and gunshot injuries</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/dNSw9ih822wKH2SaRXH11745755591.mp3", "video": ""}, {"text": "A 7-year-old boy falls off the monkey bars, landing on his outstretched hand, and immediately experiences severe pain and swelling around his elbow. An X-ray reveals a supracondylar fracture of the humerus. Which of the following features will not be seen if his radial nerve is injured?", "options": [{"label": "A", "text": "Loss of extension of metacarpophalangeal joints", "correct": false}, {"label": "B", "text": "Radial deviation of the wrist", "correct": false}, {"label": "C", "text": "Thumb weakness", "correct": false}, {"label": "D", "text": "Absence of triceps reflex", "correct": true}], "correct_answer": "D. Absence of triceps reflex", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/lsqAQGlkS65DNI4E95by1737797941.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:675px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low Lesions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fractures or dislocations at the elbow</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cannot extend the <span class=\"customMeta\" data-dictid=\"d7e158e089169277719265674b2879\">metacarpophalangeal</span> joints <strong>(Option A ruled out)</strong></li>\n<li>Thumb weakness <strong>(Option C ruled out)</strong></li>\n<li>Radial <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> of the wrist <strong>(Option B ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High Lesions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Humerus fractures or prolonged <span class=\"customMeta\" data-dictid=\"337361b1601692777200049d28078e\">tourniquet</span> pressure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wrist drop</li>\n<li>Inability to extend MCP joints or elevate thumb</li>\n<li>Sensory loss around the <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> snuffbox</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Very High Lesions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Around the shoulder </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Weakness of wrist and hand</li>\n<li>Paralysis of <span class=\"customMeta\" data-dictid=\"8fcc203d6c16927772007de57cf5b4\">triceps</span> and<strong> absence of <span class=\"customMeta\" data-dictid=\"8fcc203d6c16927772007de57cf5b4\">triceps</span> <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> </strong><strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type of Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Open Injuries</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Immediate exploration and nerve repair or grafting</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Closed Injuries</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wait 12 weeks for recovery before exploring</li>\n<li>Use EMG if no improvement; if <span class=\"customMeta\" data-dictid=\"c35382d7d61692777185a1eeeb333c\">denervation</span> is detected, perform nerve exploration and repair or grafting</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fractures of Humerus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Assess for nerve injury on admission</li>\n<li>If the injury appears post-manipulation or internal fixation, explore and repair or <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> immediately</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recovery Management</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Perform <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> hand movements</li>\n<li>Splint the wrist in extension-cock up splint:</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1000\" src=\"https://image.prepladder.com/content/lsqAQGlkS65DNI4E95by1737797941.png\" width=\"1000\"/></p>\n<ul>\n<li>Avoid ‘lively’ hand <span class=\"customMeta\" data-dictid=\"e0c04b24581692777199eb9e3f856a\">splints</span> to prevent <span class=\"customMeta\" data-dictid=\"d7e158e089169277719265674b2879\">metacarpophalangeal</span> joint contractures</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Long-term Disability</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Use <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> transfers: <span class=\"customMeta\" data-dictid=\"51d02ec7e5169277719693f472fa48\">pronator</span> <span class=\"customMeta\" data-dictid=\"8ad930500b1692777200545684a556\">teres</span> to short <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> extensor, <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> carpi <span class=\"customMeta\" data-dictid=\"282d33f842169277719716e285a377\">radialis</span> or <span class=\"customMeta\" data-dictid=\"d4cb28e3e91692777201b2085b4f79\">ulnaris</span> to finger extensors, <span class=\"customMeta\" data-dictid=\"2a7c79c3d01692777194c9e71d569b\">palmaris</span> <span class=\"customMeta\" data-dictid=\"7ff574b4f61692777191fa536b5e6c\">longus</span> to thumb abductor</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fGTm3bG1165nE6YABsCC1743508866.mp3", "video": ""}, {"text": "Following RTA, a young male presented with swelling over his elbow. X-ray revealed the following. Which of the following statements is true about the origin of the most likely nerve affected?", "options": [{"label": "A", "text": "C8-T1", "correct": true}, {"label": "B", "text": "C5-T1", "correct": false}, {"label": "C", "text": "C5-C7", "correct": false}, {"label": "D", "text": "C7-C8", "correct": false}], "correct_answer": "A. C8-T1", "question_images": ["https://image.prepladder.com/content/PVuTdcbeaKenoMWBsOdQ1737893966.png"], "explanation_images": ["https://image.prepladder.com/content/kiCsCnxXTDAvaXWja4xq1737894057.png", "https://image.prepladder.com/content/frdRzLQybVGbcCdzPQAm1737894088.png", "https://image.prepladder.com/content/S3adduOS5aOQaaZA7lNa1737894103.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>The course of <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve:</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"2047\" src=\"https://image.prepladder.com/content/kiCsCnxXTDAvaXWja4xq1737894057.png\" width=\"2752\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Muscles supplied:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Forearm:</strong> <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">Flexor</span> carpi <span class=\"customMeta\" data-dictid=\"d4cb28e3e91692777201b2085b4f79\">ulnaris</span> and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> ½ of <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> digitorum profundus\n\t\t\t\t<ul>\n<li>High <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> paradox- In high lesions of the <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve (occur with elbow fractures or dislocations) the hand is not markedly deformed because the <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> half of <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> digitorum <span class=\"customMeta\" data-dictid=\"69427990841692777196166d7a5ec9\">profundus</span> is paralyzed and the fingers are therefore less ‘clawed’</li>\n</ul>\n</li>\n<li><strong>Hand:</strong> <span class=\"customMeta\" data-dictid=\"2a7c79c3d01692777194c9e71d569b\">Palmaris</span> brevis (superficial branch) and <span class=\"customMeta\" data-dictid=\"bebdf1cab81692777180c37e36596c\">Adductor</span> pollicis, <span class=\"customMeta\" data-dictid=\"33357d54b11692777189e2babd4674\">Hypothenar</span> muscles, Interossei and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> lumbricals (Deep branch).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Sensory supply: </strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1000\" src=\"https://image.prepladder.com/content/frdRzLQybVGbcCdzPQAm1737894088.png\" width=\"1000\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Henry Vandyke Carter \" data-hash=\"\" data-license=\"OPEN ACESS\" data-source=\"https://en.wikipedia.org/wiki/Ulnar_nerve#/media/File:Gray812and814.PNG\" data-tags=\"\" height=\"3999\" src=\"https://image.prepladder.com/content/S3adduOS5aOQaaZA7lNa1737894103.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Causes of injury:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Axilla:</strong> Axillary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> aneurysm<strong> </strong></li>\n<li><strong>Arm: </strong>Fracture <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> of humerus</li>\n<li><strong>Elbow:</strong> <span class=\"customMeta\" data-dictid=\"043a86fa0016927771998a67e65e6a\">Supracondylar</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> humerus, <strong>Fracture - <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"9cdc5a92a216927771870d4b257a80\">epicondyle</span> and of humerus</strong>; <span class=\"customMeta\" data-dictid=\"5a7668926a1692777185299ac4cf5a\">cubitus</span> <span class=\"customMeta\" data-dictid=\"e33d939e82169277720167f59b0ee2\">valgus</span> <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> causes <strong>tardy <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve palsy</strong> (slow onset)</li>\n<li><strong>Forearm:</strong> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> - <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> of radius/ulna</li>\n<li><strong>Wrist &amp; Hand:</strong> <strong>Fracture - hook of hamate</strong>; <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> aneurysm</li>\n<li><strong>The most common site of <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve <span class=\"customMeta\" data-dictid=\"025e317c8116927771870f34a94b56\">entrapment</span> is the <span class=\"customMeta\" data-dictid=\"eb3a31346916927771854371f7d15d\">cubital</span> tunnel</strong> &gt; Guyon’s canal</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5F7GUjRP3SiJyXEvW6zl1743509871.mp3", "video": ""}, {"text": "All of the following are tests done to test the nerve shown in the image except", "options": [{"label": "A", "text": "No options available", "correct": false}], "correct_answer": "Unknown", "question_images": ["https://image.prepladder.com/content/ck5h6LhyRnZuUBQkDhOE1737894344.png"], "explanation_images": ["https://image.prepladder.com/content/mgUlAauRQt8J6NnKWwYI1737894499.png", "https://image.prepladder.com/content/QrfgZu1PSlpWgYw443Ro1737894542.png", "https://image.prepladder.com/content/XpMDPeIhqEv7oeihpmUT1737894595.png", "https://image.prepladder.com/content/Vd8MESk1JQf4BjrRk4c61737894609.png", "https://image.prepladder.com/content/HQt0qENKRKlSH3Q52lFG1737894624.png", "https://image.prepladder.com/content/4JKGaifzOJYgcPDIkJYr1737894640.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:618px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Action &amp; Muscle tested</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Froment’s sign:</strong></p>\n<p><strong>(Option A)</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/XpMDPeIhqEv7oeihpmUT1737894595.png\" width=\"1999\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Action tested: </strong>Adduction of the thumb</li>\n<li><strong>Muscles:</strong> <span class=\"customMeta\" data-dictid=\"236c57792f1692777194be265ad6db\">Palmar</span> interossei, <strong>Adductor pollici</strong>s.</li>\n<li><strong>Compensation:</strong> In <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve injury, to hold the paper, the patient uses <strong>Flexor pollicis longus</strong> (supplied by the <strong>median nerve</strong>) - which is responsible for the ‘P sign’ (or) ‘Froment sign’.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Card test:</strong></p>\n<p><strong>(Option D)</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"3873\" src=\"https://image.prepladder.com/content/Vd8MESk1JQf4BjrRk4c61737894609.png\" width=\"3872\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Action tested:</strong> <span class=\"customMeta\" data-dictid=\"9efe7f9e921692777180ed75f4948a\">Adduction</span> of fingers</li>\n<li><strong>Muscle:</strong> <span class=\"customMeta\" data-dictid=\"236c57792f1692777194be265ad6db\">Palmar</span> interossei</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Egawa test:</strong></p>\n<p><strong>(Option C)</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"3873\" src=\"https://image.prepladder.com/content/HQt0qENKRKlSH3Q52lFG1737894624.png\" width=\"3872\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Action tested: </strong>Abduction of fingers</li>\n<li><strong>Muscle:</strong> <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">Dorsal</span> interossei</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Gz4zhyK5mJu9K5uTvqNk1743510400.mp3", "video": ""}, {"text": "The patient presents to you with the following deformity as shown. Which is the ideal procedure of choice to correct this deformity?", "options": [{"label": "A", "text": "Omer’s surgery", "correct": false}, {"label": "B", "text": "Boye’s tendon transfer technique", "correct": false}, {"label": "C", "text": "Modified Bunnel’s operation", "correct": true}, {"label": "D", "text": "Triple arthrodesis", "correct": false}], "correct_answer": "C. Modified Bunnel’s operation", "question_images": ["https://image.prepladder.com/content/bGuAzb6T79XVBZqcrIFL1737894870.png"], "explanation_images": ["https://image.prepladder.com/content/qIZ8Lcv6Mg8v4PeTLjjR1737894936.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Partial <span class=\"customMeta\" data-dictid=\"c2193cdaa816927771843863690961\">claw</span> hand:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Clawing:</strong> <span class=\"customMeta\" data-dictid=\"2ad2fb4cc8169277718925a677620c\">Hyperextension</span> of the <span class=\"customMeta\" data-dictid=\"d7e158e089169277719265674b2879\">metacarpophalangeal</span> joints and <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> of <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joints.</li>\n<li>Clawing is seen in 2 <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> fingers only.</li>\n<li>Seen in <strong>pure <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve injury</strong>.</li>\n<li>Also known as the true <span class=\"customMeta\" data-dictid=\"c2193cdaa816927771843863690961\">claw</span> hand.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complete <span class=\"customMeta\" data-dictid=\"c2193cdaa816927771843863690961\">claw</span> hand:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Clawing of all 4 fingers.</li>\n<li>Seen in combined<strong> <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> + <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> </strong>nerve palsy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tardy <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve palsy:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Slow-onset (over years) <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve palsy.</li>\n<li>Seen with <span class=\"customMeta\" data-dictid=\"5a7668926a1692777185299ac4cf5a\">cubitus</span> <span class=\"customMeta\" data-dictid=\"e33d939e82169277720167f59b0ee2\">valgus</span> <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> seen in <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"9cdc5a92a216927771870d4b257a80\">epicondyle</span> <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> fracture.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other deformities:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wasting of <span class=\"customMeta\" data-dictid=\"33357d54b11692777189e2babd4674\">hypothenar</span> muscles &amp; <span class=\"customMeta\" data-dictid=\"a6795c876e169277719057a1099465\">intrinsic</span> muscles of the hand.</li>\n<li>Hollow inter-metacarpal spaces in hand.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Static procedure (removal)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Zancolli Lasso procedure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dynamic procedures (tendon transfer)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Modified Bunnel technique</li>\n<li>Brand’s operation</li>\n<li>Fowler’s operation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/jls983SqtlRju0aG8qE61743510704.mp3", "video": ""}, {"text": "The child presented with swelling around the elbow joint following a fall over an outstretched hand. X-ray elbow AP &amp;amp; Lateral views are given below. Which among the following is true regarding the most likely nerve injured in this case?", "options": [{"label": "A", "text": "Descends adjacent to radial artery in the forearm", "correct": false}, {"label": "B", "text": "Supplies the 3rd and 4th lumbricals", "correct": false}, {"label": "C", "text": "Gives motor branches in the arm", "correct": false}, {"label": "D", "text": "Supplies lateral ½ of flexor digitorum profundus", "correct": true}], "correct_answer": "D. Supplies lateral ½ of flexor digitorum profundus", "question_images": ["https://image.prepladder.com/content/ZBPkL9U064fmf30Qkw261737895343.png"], "explanation_images": ["https://image.prepladder.com/content/h0n2ACwZghvlp8bhoZGh1737895374.png", "https://image.prepladder.com/content/cLh7dIIZ18apGs8xCEwb1737895396.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Course and anatomy:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/h0n2ACwZghvlp8bhoZGh1737895374.png\" width=\"500\"/></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Shreya Trivedi\" data-hash=\"\" data-license=\"CC BY NC 4.0\" data-source=\"https://www.physio-pedia.com/File:Median_nerve_course.jpg\" data-tags=\"\" height=\"550\" src=\"https://image.prepladder.com/content/cLh7dIIZ18apGs8xCEwb1737895396.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Muscles supplied:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Arm:</strong> none <strong>(Option C)</strong></li>\n<li><strong>Forearm: </strong>\n<ul>\n<li>All <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> muscles <strong>except</strong> <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">Flexor</span> carpi <span class=\"customMeta\" data-dictid=\"d4cb28e3e91692777201b2085b4f79\">ulnaris</span> and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> ½ of <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> digitorum <span class=\"customMeta\" data-dictid=\"69427990841692777196166d7a5ec9\">profundus</span> (supplied by <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve) <strong>(Option D)</strong></li>\n</ul>\n</li>\n<li><strong>Hand: </strong>\n<ul>\n<li><strong>Thenar muscles: </strong>Abductor pollicis brevis, <span class=\"customMeta\" data-dictid=\"b2e2ebbf311692777194cb8034cba4\">opponens</span> pollicis and <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> pollicis brevis</li>\n<li><strong>1st and 2nd lumbricals </strong><strong>(Option B)</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Causes of injury:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Arm:</strong> Tight <span class=\"customMeta\" data-dictid=\"337361b1601692777200049d28078e\">tourniquet</span> (most common, causes neuropraxia), <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">Humerus</span> fracture</li>\n<li><strong>Elbow:</strong> <span class=\"customMeta\" data-dictid=\"043a86fa0016927771998a67e65e6a\">Supracondylar</span> fracture, <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of elbow.</li>\n<li><strong>Wrist: </strong>Carpal tunnel syndrome</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/619i1RlMdGDfNE85ngv31743511177.mp3", "video": ""}, {"text": "The clinician performed the following test as shown. Which muscle is being tested here?", "options": [{"label": "A", "text": "Adductor pollicis", "correct": false}, {"label": "B", "text": "Flexor carpi radialis", "correct": false}, {"label": "C", "text": "Abductor pollicis brevis", "correct": true}, {"label": "D", "text": "Lateral ½ of flexor digitorum profundus", "correct": false}], "correct_answer": "C. Abductor pollicis brevis", "question_images": ["https://image.prepladder.com/content/44FdeqXFG6v47GEWb1FT1737895521.png"], "explanation_images": ["https://image.prepladder.com/content/rlKjN68qnKVFOzcLtqpc1737895559.png", "https://image.prepladder.com/content/fxv1mA90buFDG3FSVmNE1737895594.png", "https://image.prepladder.com/content/30bXOno9RcNP2MuI0xcK1737895603.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Muscle tested and action</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pen test:</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"350\" src=\"https://image.prepladder.com/content/rlKjN68qnKVFOzcLtqpc1737895559.png\" width=\"350\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Muscle:</strong> <span class=\"customMeta\" data-dictid=\"1a19c0413216927771801f371db10e\">Abductor</span> pollicis brevis <strong>(Option C)</strong></li>\n<li><strong>Action:</strong> <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">Abduction</span> of thumb</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oschner <span class=\"customMeta\" data-dictid=\"7d9fedb3a5169277718426c475e8e8\">clasp</span> test:</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"350\" src=\"https://image.prepladder.com/content/fxv1mA90buFDG3FSVmNE1737895594.png\" width=\"350\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Muscle:</strong> <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">Flexor</span> digitorum <span class=\"customMeta\" data-dictid=\"d3c34e683916927771998a3426c3a6\">superficialis</span> &amp; <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> digitorum profundus</li>\n<li><strong>Action:</strong> <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">Flexion</span> of <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> 2 digits</li>\n<li><strong>Pointing index</strong> sign seen.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thumb opposition:</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"350\" src=\"https://image.prepladder.com/content/30bXOno9RcNP2MuI0xcK1737895603.png\" width=\"350\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Muscle:</strong> <span class=\"customMeta\" data-dictid=\"b2e2ebbf311692777194cb8034cba4\">Opponens</span> pollcis</li>\n<li><strong>Action: </strong>Opposition of thumb</li>\n<li><strong>O-sign</strong> is seen in normal patients</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/AABFZvMmkJo2alsZlOfW1743511281.mp3", "video": ""}, {"text": "A 40-year-old male following RTA presented with a deformity of the lower limb. The clinician prescribed him a splint as shown below. What is the likely site of injury in this patient based on the markings in this X-ray?", "options": [{"label": "A", "text": "1", "correct": false}, {"label": "B", "text": "2", "correct": false}, {"label": "C", "text": "3", "correct": false}, {"label": "D", "text": "4", "correct": true}], "correct_answer": "D. 4", "question_images": ["https://image.prepladder.com/content/gtebzn57QhO8Mus9tsqa1737895773.png", "https://image.prepladder.com/content/7cGOoIOeKLdTpwH7ldyf1737895922.png"], "explanation_images": ["https://image.prepladder.com/content/1VsnBcpXkEr7Nc7k0BSu1737895855.png", "https://image.prepladder.com/content/DknOllteoT5w8ZpnjSsk1737895979.png", "https://image.prepladder.com/content/K9BxKvdtoEHtHIT1B8821737896007.png", "https://image.prepladder.com/content/P6OTN688QPkEB4sBR7YQ1737895886.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Anatomy:</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"16b76d1d1c1692777200240efcb0e2\">terminal</span> branch of the <span class=\"customMeta\" data-dictid=\"1cb6159469169277719843ab627a07\">sciatic</span> nerve arises from the popliteal fossa.</li>\n<li><strong>Root value:</strong> L4,L5,S1 &amp; S2.</li>\n<li>Hooks around the neck of the fibula.</li>\n<li>Terminates by dividing into Superficial <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">peroneal</span> nerve &amp; Deep <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">peroneal</span> nerve</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Muscles supplied:</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Superficial <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">peroneal</span> nerve:</strong> Peroneus <span class=\"customMeta\" data-dictid=\"7ff574b4f61692777191fa536b5e6c\">longus</span> &amp; brevis (foot eversion)</li>\n<li><strong>Deep <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">peroneal</span> nerve:</strong> Peroneus tertius, Tibialis anterior, Extensor digitorum, Extensor hallucis longus.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cutaneous supply of foot:</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/K9BxKvdtoEHtHIT1B8821737896007.png\" width=\"400\"/></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Common <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">peroneal</span> nerve injury:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Most common: Neck of <span class=\"customMeta\" data-dictid=\"9e7e90693316927772027cba1a6018\">fibula</span> fracture</strong><strong> (Option D)</strong></li>\n<li>Posterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of the hip</li>\n<li>Fracture <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> condyle</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Foot drop</strong> (inability to evert)</li>\n<li><strong>High stepping gait</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Conservative (mainstay): <span class=\"customMeta\" data-dictid=\"82bdbd3b8616927772024e0c20a19a\">Foot drop</span> splint</strong></li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/P6OTN688QPkEB4sBR7YQ1737895886.png\" width=\"400\"/></p>\n<ul>\n<li>Surgical (tendon transfer) - only done &gt;12 months of no recovery:\n\t\t\t\t<ul>\n<li>Barr’s technique</li>\n<li>Ober’s technique</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/LCKsdEin5iWRJOf36tyO1743511429.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 26 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 11</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Nerve Injuries-Previous Year Questions - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 11</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 11 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which nerve will be involved in the following finding on rest?", "options": [{"label": "A", "text": "Ulnar", "correct": true}, {"label": "B", "text": "Median", "correct": false}, {"label": "C", "text": "Musculocutaneous", "correct": false}, {"label": "D", "text": "None", "correct": false}], "correct_answer": "A. Ulnar", "question_images": ["https://image.prepladder.com/content/fVELYacsj2fd8tinw56l1741092176.png"], "explanation_images": ["https://image.prepladder.com/content/XOAlT145EZ8iI9vzQxnu1741059038.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Partial <span class=\"customMeta\" data-dictid=\"c2193cdaa816927771843863690961\">claw</span> hand:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Clawing:</strong> <span class=\"customMeta\" data-dictid=\"2ad2fb4cc8169277718925a677620c\">Hyperextension</span> of the <span class=\"customMeta\" data-dictid=\"d7e158e089169277719265674b2879\">metacarpophalangeal</span> joints and <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> of <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joints.</li>\n<li>Clawing is seen in 2 <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> fingers only.</li>\n<li>Seen in <strong>pure <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve injury</strong>.</li>\n<li>Also known as the true <span class=\"customMeta\" data-dictid=\"c2193cdaa816927771843863690961\">claw</span> hand.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complete <span class=\"customMeta\" data-dictid=\"c2193cdaa816927771843863690961\">claw</span> hand:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Clawing of all 4 fingers.</li>\n<li>Seen in combined<strong> <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> + <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> </strong>nerve palsy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tardy <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve palsy:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Slow-onset (over years) <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve palsy.</li>\n<li>Seen with <span class=\"customMeta\" data-dictid=\"5a7668926a1692777185299ac4cf5a\">cubitus</span> <span class=\"customMeta\" data-dictid=\"e33d939e82169277720167f59b0ee2\">valgus</span> <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> seen in <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"9cdc5a92a216927771870d4b257a80\">epicondyle</span> <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> fracture.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other deformities:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wasting of <span class=\"customMeta\" data-dictid=\"33357d54b11692777189e2babd4674\">hypothenar</span> muscles &amp; <span class=\"customMeta\" data-dictid=\"a6795c876e169277719057a1099465\">intrinsic</span> muscles of the hand.</li>\n<li>Hollow inter-metacarpal spaces in hand.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Static procedure (removal)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Zancolli Lasso procedure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dynamic procedures (tendon transfer)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Modified Bunnel technique</li>\n<li>Brand’s operation</li>\n<li>Fowler’s operation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following nerve injuries is the instrument shown below used?", "options": [{"label": "A", "text": "Radial nerve", "correct": true}, {"label": "B", "text": "Median nerve", "correct": false}, {"label": "C", "text": "Ulnar nerve", "correct": false}, {"label": "D", "text": "Volkmann's ischemic contracture", "correct": false}], "correct_answer": "A. Radial nerve", "question_images": ["https://image.prepladder.com/notes/hiTrXmTsOCOQQJpdgeDR1745912209.png"], "explanation_images": ["https://image.prepladder.com/notes/hiTrXmTsOCOQQJpdgeDR1745912209.png", "https://image.prepladder.com/notes/z8K8NabVbgVTMBCGNkUb1745912210.png", "https://image.prepladder.com/notes/GktND1ys8cnozQXrZn6V1745912211.png", "https://image.prepladder.com/notes/z8eEkHmqysb0TOVstyn81745912212.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type of Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Treatment</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Open Injuries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Immediate exploration and nerve repair or grafting</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Closed Injuries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Wait 12 weeks for recovery before exploring</li>\n<li>Use EMG if no improvement; if <span class=\"customMeta\" data-dictid=\"c35382d7d61692777185a1eeeb333c\">denervation</span> is detected, perform nerve exploration and repair or grafting</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fractures of Humerus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Assess for nerve injury on admission</li>\n<li>If the injury appears post-manipulation or internal fixation, explore and repair or <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> immediately</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Recovery Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Perform <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> hand movements</li>\n<li>Splint the wrist in extension-cock up splint:\n\t\t\t\t<figure class=\"caption_element\"><img alt=\"POR064\" data-author=\"NA\" data-hash=\"11393\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/z8K8NabVbgVTMBCGNkUb1745912210.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Long-term Disability</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tendon transfers: <span class=\"customMeta\" data-dictid=\"51d02ec7e5169277719693f472fa48\">pronator</span> <span class=\"customMeta\" data-dictid=\"8ad930500b1692777200545684a556\">teres</span> to short <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> extensor, <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> carpi <span class=\"customMeta\" data-dictid=\"282d33f842169277719716e285a377\">radialis</span> or <span class=\"customMeta\" data-dictid=\"d4cb28e3e91692777201b2085b4f79\">ulnaris</span> to finger extensors, <span class=\"customMeta\" data-dictid=\"2a7c79c3d01692777194c9e71d569b\">palmaris</span> <span class=\"customMeta\" data-dictid=\"7ff574b4f61692777191fa536b5e6c\">longus</span> to thumb abductor</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the orthopedics outpatient department, a female patient is presenting with difficulty sleeping at night due to experiencing numbness and tingling in the outer three digits of their hand. The symptoms improve when the patient hangs their arms from the bed. Which of the following choices accurately identifies the patient's condition and the test employed to evaluate it?", "options": [{"label": "A", "text": "Guyon's canal syndrome, Froment's test", "correct": false}, {"label": "B", "text": "Carpal tunnel syndrome, Froment's test", "correct": false}, {"label": "C", "text": "Guyon's canal syndrome, Durkan's test", "correct": false}, {"label": "D", "text": "Carpal tunnel syndrome, Durkan's test", "correct": true}], "correct_answer": "D. Carpal tunnel syndrome, Durkan's test", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/Hsk8uJjOI86y49MVa7hX1745912212.png", "https://image.prepladder.com/content/0bco0RrAyFPdZE1rdyt91745301885.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:621px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Compression of the <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> nerve as it passes through the <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> tunnel in the wrist</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Numbness, <span class=\"customMeta\" data-dictid=\"b7020a23961692777200b1237ae429\">tingling</span> in thumb, index, and middle fingers</li>\n<li>Pain in hand and wrist, Weakness in grip</li>\n<li>Symptoms often <strong>worse at night </strong>and improve during the day.</li>\n<li>Advanced cases may lead to hand weakness, clumsiness, and muscle atrophy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Structures Affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Median Nerve</strong>: Compressed within the <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> tunnel, leading to symptoms and signs.</li>\n<li><strong>Flexor Tendons</strong>: The nine <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> tendons passing through the <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> tunnel can become inflamed, further compressing the <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> nerve.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Structures Spared</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Thenar Eminence</strong>: <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">Sensory</span> loss generally spares this area because its nerve (palmar <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> nerve) bypasses the <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> tunnel.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Weakness: </strong>Notable weakness in thumb <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> and opposition.</li>\n<li><strong>Atrophy</strong>: Possible <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> of the <span class=\"customMeta\" data-dictid=\"48c587f4c51692777200fe869f1699\">thenar</span> <span class=\"customMeta\" data-dictid=\"c7cd7c82631692777187abb016ed2e\">eminence</span> in advanced cases.</li>\n<li><strong>Sensory Loss</strong>: Loss typically affects the <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> nerve distribution (thumb, index, middle, and <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> half of the fourth digit).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Idiopathic-</strong> commonest cause</li>\n<li><strong>Inflammatory causes- </strong>Rheumatoid arthritis, wrist osteoarthritis</li>\n<li><strong>Post-traumatic causes-</strong> Bone thickening after a Colles' fracture</li>\n<li><strong>Endocrine causes-</strong> Myxoedema, Acromegaly</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nerve Conduction Studies (NCS) - primary <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test</li>\n<li>Electromyography (EMG)</li>\n<li><strong>Phalen Test:</strong> Positive if pain/paresthesias arise during wrist flexion.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"LittleT889\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Phalen%27s_Maneuver.jpg\" data-tags=\"\" height=\"277\" src=\"https://image.prepladder.com/content/0bco0RrAyFPdZE1rdyt91745301885.png\" width=\"578\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<ul>\n<li><strong>Tinel Test:</strong> Positive if tapping over the <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> tunnel elicits symptoms.</li>\n<li><strong>Durkan test:</strong> Direct <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> on <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">Median</span> nerve for 30 seconds. <strong>More specific</strong> than the Phalen/Tinel test.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Conservative: Wrist splinting, NSAIDs, activity modification</li>\n<li>Corticosteroid injections</li>\n<li>Surgical: <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">Carpal</span> tunnel release (for severe or <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> cases)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The type of splint shown in the image is known as?", "options": [{"label": "A", "text": "Wrist splint", "correct": false}, {"label": "B", "text": "Cock-up splint", "correct": true}, {"label": "C", "text": "Knuckle bender splint", "correct": false}, {"label": "D", "text": "Dynamic finger splint", "correct": false}], "correct_answer": "B. Cock-up splint", "question_images": ["https://image.prepladder.com/notes/ZK8mirresjSYMOvWkELn1747916074.png"], "explanation_images": ["https://image.prepladder.com/notes/ZK8mirresjSYMOvWkELn1747916074.png", "https://image.prepladder.com/notes/RvYG03pvtUA07zKTBGiP1747916149.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type of Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Treatment</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Open Injuries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Immediate exploration and nerve repair or grafting</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Closed Injuries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Wait 12 weeks for recovery before exploring</li>\n<li>Use EMG if no improvement; if <span class=\"customMeta\" data-dictid=\"c35382d7d61692777185a1eeeb333c\">denervation</span> is detected, perform nerve exploration and repair or grafting</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fractures of Humerus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Assess for nerve injury on admission</li>\n<li>If the injury appears post-manipulation or internal fixation, explore and repair or <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> immediately</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Recovery Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Perform <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> hand movements</li>\n<li>Splint the wrist in extension-cock up splint:<img alt=\" Extension cock up splint\" data-author=\"\" data-hash=\"13199\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/RvYG03pvtUA07zKTBGiP1747916149.png\"/></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Long-term Disability</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tendon transfers: <span class=\"customMeta\" data-dictid=\"51d02ec7e5169277719693f472fa48\">pronator</span> <span class=\"customMeta\" data-dictid=\"8ad930500b1692777200545684a556\">teres</span> to short <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> extensor, <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> carpi <span class=\"customMeta\" data-dictid=\"282d33f842169277719716e285a377\">radialis</span> or <span class=\"customMeta\" data-dictid=\"d4cb28e3e91692777201b2085b4f79\">ulnaris</span> to finger extensors, <span class=\"customMeta\" data-dictid=\"2a7c79c3d01692777194c9e71d569b\">palmaris</span> <span class=\"customMeta\" data-dictid=\"7ff574b4f61692777191fa536b5e6c\">longus</span> to thumb abductor</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "While examining a patient with a right forearm fracture, you ask him to make a fist. The following finding is noted during this procedure. What is the sign called?", "options": [{"label": "A", "text": "Froment’s sign", "correct": false}, {"label": "B", "text": "Pointing index sign", "correct": true}, {"label": "C", "text": "Benediction sign", "correct": false}, {"label": "D", "text": "Policeman tip deformity", "correct": false}], "correct_answer": "B. Pointing index sign", "question_images": ["https://image.prepladder.com/notes/c6UfQTKeG1p3RByX9gjp1747916572.png"], "explanation_images": ["https://image.prepladder.com/notes/c6UfQTKeG1p3RByX9gjp1747916572.png", "https://image.prepladder.com/notes/D22k6mkj0I5m2anTgBTz1747916624.png", "https://image.prepladder.com/notes/OoWy3Q8eB5glCj3Zw5491747916659.png", "https://image.prepladder.com/notes/b03yVaw5iLbpqOnaOudy1747916703.png", "https://image.prepladder.com/notes/WDngOwAWP5LhrvgH87ua1747916926.png", "https://image.prepladder.com/notes/JzWtOUmHTTapn6cD1WRu1747917000.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Muscle tested and action</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pen test:</strong></p>\n<p><img alt=\"Pen test\" data-author=\"\" data-hash=\"13204\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/D22k6mkj0I5m2anTgBTz1747916624.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Muscle:</strong> Abductor pollicis brevis</li>\n<li><strong>Action:</strong> <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">Abduction</span> of thumb</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Oschner <span class=\"customMeta\" data-dictid=\"7d9fedb3a5169277718426c475e8e8\">clasp</span> test:</strong><img alt=\"Oschner clasp test\" data-author=\"\" data-hash=\"13205\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/OoWy3Q8eB5glCj3Zw5491747916659.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Muscle:</strong> <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">Flexor</span> digitorum <span class=\"customMeta\" data-dictid=\"d3c34e683916927771998a3426c3a6\">superficialis</span> &amp; <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> digitorum profundus</li>\n<li><strong>Action:</strong> Flexion of <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> 2 digits</li>\n<li><strong>Pointing index</strong> sign seen.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thumb opposition:</strong></p>\n<p><img alt=\"Thumb opposition\" data-author=\"\" data-hash=\"13206\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/b03yVaw5iLbpqOnaOudy1747916703.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Muscle:</strong> Opponens pollcis</li>\n<li><strong>Action: </strong>Opposition of thumb</li>\n<li><strong>O-sign</strong> is seen in normal patients</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The patient experiences an inability to extend their wrist upon waking up after sleeping with their arm hanging over the back of a chair. This condition is caused by", "options": [{"label": "A", "text": "Neurotmesis", "correct": false}, {"label": "B", "text": "Neurolysis", "correct": false}, {"label": "C", "text": "Axonotmesis", "correct": false}, {"label": "D", "text": "Neuropraxia", "correct": true}], "correct_answer": "D. Neuropraxia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cDuO5qUzddAugcduJJMY1747908090.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:568px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neurapraxia</strong></p>\n<p><strong>(Grade I)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Temporary <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> block, <span class=\"customMeta\" data-dictid=\"47fec911a316927771933b7607bdf0\">myelin</span> damage only.</li>\n<li>No <span class=\"customMeta\" data-dictid=\"11117a474a1692777193044082d47a\">neuroma</span> and no degeneration.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Recovery is complete within 6 weeks.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Axonotmesis</strong></p>\n<p><strong>(Grade II)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Axonal damage, <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue intact.</li>\n<li>Neuroma in continuity.</li>\n<li>Degeneration: Proximally+distally.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Recovery can take up to months</li>\n<li>Complete recovery may not occur.</li>\n<li>Motor march present</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neurotmesis</strong></p>\n<p><strong>(Grade III)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Complete nerve disruption.</li>\n<li>End or side neuroma.</li>\n<li>Degeneration: Proximally+distally.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Spontaneous recovery never occurs.</li>\n<li>Repair is required (poor recovery)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "After a surgical procedure, the patient demonstrates a particular clinical sign. Which specific nerve is likely to be damaged in this case?", "options": [{"label": "A", "text": "Radial nerve", "correct": false}, {"label": "B", "text": "Median nerve", "correct": true}, {"label": "C", "text": "Ulnar nerve", "correct": false}, {"label": "D", "text": "Radial artery", "correct": false}], "correct_answer": "B. Median nerve", "question_images": ["https://image.prepladder.com/content/x2EjaLeRCn8tJ7K6EYPr1747908176.png"], "explanation_images": ["https://image.prepladder.com/content/39un6TuO7j8k5ggpdr9g1747908181.png", "https://image.prepladder.com/content/tvU6PSTZDk4H38NiSJBO1746078684.png", "https://image.prepladder.com/content/wo3AeDPj4k9iz63MFsne1746078684.png", "https://image.prepladder.com/content/PuG6wfgmQVhNU4Qry6M11746078684.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Muscle tested and action</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pen test:</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"211\" src=\"https://image.prepladder.com/content/tvU6PSTZDk4H38NiSJBO1746078684.png\" width=\"198\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Muscle:</strong> Abductor pollicis brevis</li>\n<li><strong>Action:</strong> Abduction of thumb</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Oschner <span class=\"customMeta\" data-dictid=\"7d9fedb3a5169277718426c475e8e8\">clasp</span> test:</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"220\" src=\"https://image.prepladder.com/content/wo3AeDPj4k9iz63MFsne1746078684.png\" width=\"172\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Muscle:</strong> <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">Flexor</span> digitorum <span class=\"customMeta\" data-dictid=\"d3c34e683916927771998a3426c3a6\">superficialis</span> &amp; <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> digitorum profundus</li>\n<li><strong>Action:</strong> Flexion of <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> 2 digits</li>\n<li><strong>Pointing index</strong> sign seen.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thumb opposition:</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"233\" src=\"https://image.prepladder.com/content/PuG6wfgmQVhNU4Qry6M11746078684.png\" width=\"162\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Muscle:</strong> Opponens pollcis</li>\n<li><strong>Action: </strong>Opposition of thumb</li>\n<li><strong>O-sign</strong> is seen in normal patients</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What condition is caused by nerve injury?", "options": [{"label": "A", "text": "Ulnar nerve", "correct": true}, {"label": "B", "text": "Radial nerve", "correct": false}, {"label": "C", "text": "Median nerve", "correct": false}, {"label": "D", "text": "Posterior interosseous nerve", "correct": false}], "correct_answer": "A. Ulnar nerve", "question_images": ["https://image.prepladder.com/notes/eddRNLDp4ne8YClDMU6E1746433113.png"], "explanation_images": ["https://image.prepladder.com/notes/rPFuP974mlLV3cXVv6tH1746433225.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Partial <span class=\"customMeta\" data-dictid=\"c2193cdaa816927771843863690961\">claw</span> hand:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Clawing:</strong> <span class=\"customMeta\" data-dictid=\"2ad2fb4cc8169277718925a677620c\">Hyperextension</span> of the <span class=\"customMeta\" data-dictid=\"d7e158e089169277719265674b2879\">metacarpophalangeal</span> joints and <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> of <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joints.</li>\n<li>Clawing is seen in 2 <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> fingers only.</li>\n<li>Seen in <strong>pure <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve injury</strong>.</li>\n<li>Also known as the true <span class=\"customMeta\" data-dictid=\"c2193cdaa816927771843863690961\">claw</span> hand.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complete <span class=\"customMeta\" data-dictid=\"c2193cdaa816927771843863690961\">claw</span> hand:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Clawing of all 4 fingers.</li>\n<li>Seen in combined<strong> <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> + <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> </strong>nerve palsy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tardy <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve palsy:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Slow-onset (over years) <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve palsy.</li>\n<li>Seen with <span class=\"customMeta\" data-dictid=\"5a7668926a1692777185299ac4cf5a\">cubitus</span> <span class=\"customMeta\" data-dictid=\"e33d939e82169277720167f59b0ee2\">valgus</span> <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> seen in <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"9cdc5a92a216927771870d4b257a80\">epicondyle</span> <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> fracture.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other deformities:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wasting of <span class=\"customMeta\" data-dictid=\"33357d54b11692777189e2babd4674\">hypothenar</span> muscles &amp; <span class=\"customMeta\" data-dictid=\"a6795c876e169277719057a1099465\">intrinsic</span> muscles of the hand.</li>\n<li>Hollow inter-metacarpal spaces in hand.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Static procedure (removal)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Zancolli Lasso procedure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dynamic procedures (tendon transfer)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Modified Bunnel technique</li>\n<li>Brand’s operation</li>\n<li>Fowler’s operation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "When the outer sheath and nerve fiber remain intact while the inner axons are affected, this condition is referred to as", "options": [{"label": "A", "text": "Neurapraxia", "correct": false}, {"label": "B", "text": "Axonapraxia", "correct": false}, {"label": "C", "text": "Axonotmesis", "correct": true}, {"label": "D", "text": "Neurotmesis", "correct": false}], "correct_answer": "C. Axonotmesis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/6xGiCXoCveYBY1EWUK9D1745559001.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:568px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Neurapraxia</p>\n<p>(Grade I) <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Temporary <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> block, <span class=\"customMeta\" data-dictid=\"47fec911a316927771933b7607bdf0\">myelin</span> damage only.</li>\n<li>No <span class=\"customMeta\" data-dictid=\"11117a474a1692777193044082d47a\">neuroma</span> and no degeneration.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Recovery is complete within 6 weeks.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Axonotmesis</p>\n<p>(Grade II) <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Axonal damage, <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue intact.</li>\n<li>Neuroma in continuity.</li>\n<li>Degeneration: Proximally+distally.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Recovery can take up to months</li>\n<li>Complete recovery may not occur.</li>\n<li>Motor march present</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Neurotmesis</p>\n<p>(Grade III) <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Complete nerve disruption.</li>\n<li>End or side neuroma.</li>\n<li>Degeneration: Proximally+distally.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Spontaneous recovery never occurs.</li>\n<li>Repair is required (poor recovery)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The following test is done to assess?", "options": [{"label": "A", "text": "Posterior interosseous nerve", "correct": false}, {"label": "B", "text": "Ulnar nerve", "correct": false}, {"label": "C", "text": "Musculocutaneous nerve", "correct": false}, {"label": "D", "text": "Median nerve", "correct": true}], "correct_answer": "D. Median nerve", "question_images": ["https://image.prepladder.com/content/tdwyY2FmRLj2QxOWaQca1745392685.png"], "explanation_images": ["https://image.prepladder.com/content/vN65lwmFTVuS7cZhowHX1745392771.png", "https://image.prepladder.com/content/H9HCl7bxXJwRRS3HGHbG1745392810.png", "https://image.prepladder.com/content/270i4ZbXqaeXfLP54s5J1745392844.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Muscle tested and action</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pen test:</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"213\" src=\"https://image.prepladder.com/content/vN65lwmFTVuS7cZhowHX1745392771.png\" width=\"212\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Muscle:</strong> <span class=\"customMeta\" data-dictid=\"1a19c0413216927771801f371db10e\">Abductor</span> pollicis brevis <strong>(Option C)</strong></li>\n<li><strong>Action:</strong> <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">Abduction</span> of thumb</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oschner <span class=\"customMeta\" data-dictid=\"7d9fedb3a5169277718426c475e8e8\">clasp</span> test:</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"229\" src=\"https://image.prepladder.com/content/H9HCl7bxXJwRRS3HGHbG1745392810.png\" width=\"228\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Muscle:</strong> <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">Flexor</span> digitorum <span class=\"customMeta\" data-dictid=\"d3c34e683916927771998a3426c3a6\">superficialis</span> &amp; <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> digitorum profundus</li>\n<li><strong>Action:</strong> <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">Flexion</span> of <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> 2 digits</li>\n<li><strong>Pointing index</strong> sign seen.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thumb opposition:</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"223\" src=\"https://image.prepladder.com/content/270i4ZbXqaeXfLP54s5J1745392844.png\" width=\"222\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Muscle:</strong> <span class=\"customMeta\" data-dictid=\"b2e2ebbf311692777194cb8034cba4\">Opponens</span> pollcis</li>\n<li><strong>Action: </strong>Opposition of thumb</li>\n<li><strong>O-sign</strong> is seen in normal patients</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old man presents with numbness of both hands. He was asked to perform the test demonstrated below. What is the name of this test?", "options": [{"label": "A", "text": "Adson's test", "correct": false}, {"label": "B", "text": "Pemberton test", "correct": false}, {"label": "C", "text": "Roos test", "correct": true}, {"label": "D", "text": "Wright test", "correct": false}], "correct_answer": "C. Roos test", "question_images": ["https://image.prepladder.com/content/bwRsT0HTRhPWSQzeW1231691418590.png"], "explanation_images": ["https://image.prepladder.com/content/Xrdq3D22LoZ6jLXj3VLt1713444431.png", "https://image.prepladder.com/content/SsArpxLUKQ2oBEnp7eE91713444538.png"], "explanation": "<p>Correct Option C - R\n<table>\n<thead>\n<tr>\n<td>\n<p><strong>Test</strong></p>\n</td>\n<td>\n<p><strong>Description</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>\n<p>Adson's test</p>\n</td>\n<td>\n<p>A test used to evaluate <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> outlet syndrome by checking the <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> pulse while the patient rotates their head and extends their neck.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pemberton test</p>\n</td>\n<td>\n<p>A test used to assess for <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> outlet syndrome caused by the <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> of structures between the <span class=\"customMeta\" data-dictid=\"2cb340bacd169277718404028c7d00\">clavicle</span> and the first rib. It involves raising both arms above the head while monitoring for symptoms.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Roos test</p>\n</td>\n<td>\n<p>Also known as the \"Elevated Arm Stress Test\" or \"Chicken Wing Test,\" it is used to evaluate <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> outlet syndrome by having the patient elevate both arms, <span class=\"customMeta\" data-dictid=\"73eb6a06aa1692777202a9f27fafa2\">flex</span> the elbows, and open and close their hands for several minutes.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Wright test</p>\n</td>\n<td>The Wright test, also known as the Hyperabduction Test, is a clinical examination used to diagnose <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> outlet syndrome (TOS). The Wright test specifically assesses for <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> of the <span class=\"customMeta\" data-dictid=\"9562c879be1692777199afcb12fa54\">subclavian</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> and the <span class=\"customMeta\" data-dictid=\"1e4db8b6ad1692777183683f42d44b\">brachial</span> <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> by the <span class=\"customMeta\" data-dictid=\"afa97794e21692777195a324ffec49\">pectoralis</span> minor muscle.</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 21 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 16</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Pediatric Orthopedics-Pediatric Orthopedics - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 16</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 16 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "The MEOX1-mutated Klippel-Feil syndrome shows which type of inheritance pattern?", "options": [{"label": "A", "text": "Autosomal dominant", "correct": false}, {"label": "B", "text": "Autosomal recessive", "correct": true}, {"label": "C", "text": "X-linked dominant", "correct": false}, {"label": "D", "text": "X-linked recessive", "correct": false}], "correct_answer": "B. Autosomal recessive", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/p0qLGS35ZUZ3QMC6raJc1737995634.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:482px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type I</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Single, congenitally fused segment.</li>\n<li>About 25% of the patients.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type II</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Multiple, <span class=\"customMeta\" data-dictid=\"9996ef505516927771937fe4ef1222\">non</span> contiguous, congenitally fused segment.</li>\n</ul>\n<ul>\n<li>About 50% of the patients.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type III</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Multiple, contiguous, congenitally fused segment.</li>\n</ul>\n<ul>\n<li>About 25% of the patients.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Can result from mutations in genes like GDF6, GDF3 or MEOX1.</li>\n<li>Inheritance can be <strong>autosomal dominant (M/C- GDF3,GDF6) or autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> (MEOX1 mutations).</strong></li>\n<li>Also associated with <strong>fetal alcohol syndrome, <span class=\"customMeta\" data-dictid=\"59f10f2f2d1692777188a7490e7c4e\">Goldenhar syndrome</span> and Sprengel deformity.</strong></li>\n<li><strong>Sprengel <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> or <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">Congenital</span> <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> of the scapula</strong> is an <span class=\"customMeta\" data-dictid=\"50a440f85816927771817d2fe50984\">anomaly</span> of the shoulder <span class=\"customMeta\" data-dictid=\"a1d37a92d41692777188e12a817797\">girdle</span> that is associated with <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> descent, and altered position and <span class=\"customMeta\" data-dictid=\"9e99effc421692777181b02606e021\">anatomy</span> of the scapula.The <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> is usually associated with muscle <span class=\"customMeta\" data-dictid=\"35c595890e1692777189a68438427a\">hypoplasia</span> or atrophy.</li>\n</ul>\n<br/>\n<img alt=\"\" data-author=\"Alper Dilli, Umit Yaşar Ayaz, Çağrı Damar, Onder Ersan, Baki Hekimoğlu\" data-hash=\"\" data-license=\"CC BY-NC SA 3.0\" data-source=\"https://www.researchgate.net/figure/A-7-year-old-girl-showing-Sprengel-deformity-on-the-right-shoulder-a-b-c-The-right_fig1_51697435\" data-tags=\"\" height=\"230\" src=\"https://image.prepladder.com/content/p0qLGS35ZUZ3QMC6raJc1737995634.png\" width=\"500\"/><br/>\n\t\t\t \n\t\t\t<ul>\n<li><strong>The MEOX1 gene encodes the <span class=\"customMeta\" data-dictid=\"6dc6ae1a881692777189bc4a1a932c\">homeobox</span> protein MOX1</strong>, which regulates vertebral separation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Faulty<strong> </strong>cervical spine <span class=\"customMeta\" data-dictid=\"aa998dc528169277719850af075181\">segmentation</span> occurs during 3-8 weeks of embryonic development resulting in persistent <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> of involved vertebrae.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Risk of <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord injury due to instability.</li>\n<li>Hearing loss</li>\n<li>Scoliosis</li>\n<li>Disc degeneration</li>\n<li>Spondylosis</li>\n<li>Spinal <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> stenosis</li>\n<li>Disc herniation</li>\n<li>Osteophyte formation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Differential diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Various <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> conditions may present similar to <span class=\"customMeta\" data-dictid=\"77493a5b781692777193df12530299\">neonatal</span> <span class=\"customMeta\" data-dictid=\"04200ee7031692777190afae9eb423\">Klippel-Feil syndrome</span> such as:</p>\n\t\t\t \n\n\t\t\t<ul>\n<li>Mayer-Rokitansky-Kuster-Hauser syndrome</li>\n<li>VACTERL - Vertebral defect, Anal atresia, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> defect, <span class=\"customMeta\" data-dictid=\"475476487516927772007d27e8da21\">Tracheoesophageal</span> fistula, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> and limb defects.</li>\n<li>Wildervanck syndrome</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/2dr6hvD8CJHEK4FXTcsC1743512351.mp3", "video": ""}, {"text": "A 10 M/O girl baby is brought to the pediatric clinic by her parents due to concerns about her short neck, limited ability to turn her head, and a low hairline at the back of her neck. On physical examination, the child exhibits restricted neck mobility and mild scoliosis. Radiographic imaging shows fusion of the C2-C3 vertebrae.Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "VACTERL association", "correct": false}, {"label": "B", "text": "Wildervanck syndrome", "correct": false}, {"label": "C", "text": "Mayer-Rokitansky-Küster-Hauser syndrome", "correct": false}, {"label": "D", "text": "Klippel-Feil syndrome", "correct": true}], "correct_answer": "D. Klippel-Feil syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/PkpJDb5v1afScOcPBEsf1737995815.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Triad of Short neck, Limited neck mobility, Low <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> hairline.</strong></li>\n<li>Scoliosis, hearing loss, or other organ anomalies.</li>\n<li>Facial dysmorphism</li>\n<li>Microcephaly</li>\n<li>Abnormal <span class=\"customMeta\" data-dictid=\"068d6642471692777198d89a1be687\">sensorimotor</span> function and reflexes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Ultrasonography: </strong>Detecting <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> vertebral <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> and associated cardiac, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> and <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> anomalies.</li>\n<li><strong>Plain Radiography: </strong>Assess the extent of <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> vertebral fusion.</li>\n<li><strong>CT scan:</strong> For <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> of bony fusion.</li>\n<li><strong>MRI: </strong>Used for evaluating the integrity of <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord, disc space and nerve rootlets.</li>\n<li><strong>Genetic testing</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most patients receive non-operative treatment except in cases of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> neurological deficits, <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> instability.</p>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/PkpJDb5v1afScOcPBEsf1737995815.png\" width=\"500\"/></p>\n<p><strong>Non <span class=\"customMeta\" data-dictid=\"f79470fd4a16927771940b525da4db\">operative</span> management</strong></p>\n<p> </p>\n<ul>\n<li>Physical therapy</li>\n<li>Pain management</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Operative management</strong></p>\n\t\t\t \n\n\t\t\t<p><strong>Anterior approach:</strong></p>\n<ul>\n<li>Anterior <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> or <span class=\"customMeta\" data-dictid=\"05d44a78cc169277718581c62c6943\">corpectomy</span> with <span class=\"customMeta\" data-dictid=\"61fbe2173416927771998e7aa0b432\">synthetic</span> or <span class=\"customMeta\" data-dictid=\"c293dda462169277718335b755e1a9\">bone graft</span> placement.</li>\n<li>Cervical total disc arthroplasty</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Posterior approach: </strong>Decompression and fusion</p>\n<ul>\n<li><strong>Surgical or <span class=\"customMeta\" data-dictid=\"b58e8c69891692777183e7f09ab6a7\">bracing</span> intervention</strong> may be necessary for associated <span class=\"customMeta\" data-dictid=\"8c77461be01692777184e67e678209\">compensatory</span> <strong>thoracic scoliosis</strong>.</li>\n<li>Patients with <span class=\"customMeta\" data-dictid=\"4bc4237fe31692777189178ad8b19e\">hearing impairment</span> may require otolaryngological evaluation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Risk of <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord injury due to instability.</li>\n<li>Hearing loss</li>\n<li>Scoliosis</li>\n<li>Disc degeneration</li>\n<li>Spondylosis</li>\n<li>Spinal <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> stenosis</li>\n<li>Disc herniation</li>\n<li>Osteophyte formation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Differential diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Various <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> conditions may present similar to <span class=\"customMeta\" data-dictid=\"77493a5b781692777193df12530299\">neonatal</span> <span class=\"customMeta\" data-dictid=\"04200ee7031692777190afae9eb423\">Klippel-Feil syndrome</span> such as:</p>\n\t\t\t \n\n\t\t\t<ul>\n<li>Mayer-Rokitansky-Kuster-Hauser syndrome</li>\n<li>VACTERL - Vertebral defect, Anal atresia, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> defect, <span class=\"customMeta\" data-dictid=\"475476487516927772007d27e8da21\">Tracheoesophageal</span> fistula, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> and limb defects.</li>\n<li>Wildervanck syndrome</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/HqdidlIQxBsh0R7YZCuh1743512608.mp3", "video": ""}, {"text": "A 9-month-old infant is brought to the emergency department by their parents due to lethargy and vomiting. The parents claim the child fell from the couch the previous day. On examination, the child has multiple bruises of varying ages on the torso and arms, along with swelling over the left side of the head. A skeletal survey reveals posterior rib fractures and a healing spiral fracture of the left femur. Ophthalmologic examination shows retinal hemorrhages. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Paget disease", "correct": false}, {"label": "B", "text": "Osteogenesis imperfecta", "correct": false}, {"label": "C", "text": "Battered baby syndrome", "correct": true}, {"label": "D", "text": "Vitamin D deficiency (Rickets)", "correct": false}], "correct_answer": "C. Battered baby syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wE28wOCWmyRHA1vQMvcL1738001592.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Multiple injuries at different stages of healing.</li>\n<li>Bruises, fractures, burns, and lacerations, often in unusual places like the back, buttocks, or thighs.</li>\n<li>Rib fractures (posterior or lateral), long bone fractures (especially <span class=\"customMeta\" data-dictid=\"0b34a9891d16927771998a84595013\">spiral</span> fractures), and skull fractures.</li>\n<li>Retinal hemorrhages or <span class=\"customMeta\" data-dictid=\"a9f86efa0d169277719911e454bd12\">subdural</span> hematomas, often associated with shaken baby syndrome, a <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of abusive head trauma.</li>\n<li>Fracture in <span class=\"customMeta\" data-dictid=\"8ccb80bd4d169277719296d80e2193\">metaphysis</span> of bone</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiographic Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fractures of varying ages are highly suspicious (old <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> fractures along with recent ones).</li>\n<li>Classic metaphyseal lesions (CML), often found in infants, are indicative of twisting or pulling forces.</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li>Posterior rib fractures suggest forceful squeezing.</li>\n<li>Skull fractures may be seen with head trauma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Signs of Abuse</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inconsistent history provided by the caregiver.</li>\n<li>Delay in seeking medical care despite severe injuries.</li>\n<li>Injuries inconsistent with the child's developmental stage (e.g., infants with fractures who cannot yet walk).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Syndromes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Shaken Baby Syndrome (SBS): </strong>A <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of <span class=\"customMeta\" data-dictid=\"197ce56f051692777184f80417158b\">child abuse</span> resulting in brain injury caused by violent shaking. It can lead to severe neurological damage or death.</li>\n</ul>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/wE28wOCWmyRHA1vQMvcL1738001592.png\" width=\"500\"/><br/>\n<br/>\n\t\t\t \n\t\t\t<ul>\n<li><strong>Munchausen Syndrome: </strong>A caregiver intentionally causes illness or injury in a child to gain attention.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A thorough physical exam and detailed history are crucial.</li>\n<li>Imaging (X-rays, CT scans, MRI) to assess for fractures, brain injury, or internal trauma.</li>\n<li>Ophthalmologic exam to check for <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> hemorrhages.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Immediate protection of the child by involving child protective services or law enforcement.</li>\n<li>Medical treatment for injuries, which may involve surgery, <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> management, or neurological intervention.</li>\n<li>Long-term psychological and social support for the child and non-abusive family members.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/s2wCl2U59dYa6RakGbhX1743512788.mp3", "video": ""}, {"text": "A 2 Y/O boy is brought to the orthopedic clinic by his parents due to concerns about his right leg. They report that he has been walking with a noticeable limp and that his right tibia appears to be bowed. On examination, there is a palpable swelling along the midshaft of the right tibia, which is tender to touch. X-rays reveal a cystic lesion at the midshaft of the tibia with a lack of continuity in the bone. The child has no history of trauma. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Osteofibrous dysplasia", "correct": false}, {"label": "B", "text": "Congenital angulation of tubular bones", "correct": false}, {"label": "C", "text": "Congenital pseudoarthrosis of the tibia", "correct": true}, {"label": "D", "text": "Monostotic fibrous dysplasia", "correct": false}], "correct_answer": "C. Congenital pseudoarthrosis of the tibia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Yj93Js7Xn3qYmXt2h7qy1738001698.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiopathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It may be related to factors such as genetic predisposition, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> insufficiency, or trauma during <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> development.</li>\n<li>It is often associated with <span class=\"customMeta\" data-dictid=\"6518acf261169277719312127935af\">neurofibromatosis</span> <span class=\"customMeta\" data-dictid=\"946a9a6be11692777201eb269e8327\">type I</span> (NF1), a genetic disorder that can lead to tumors on nerve tissue and skeletal abnormalities.</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"fc8c28347a16927771945680bd00be\">osteoclastic</span> activity due to signal abnormalities or decreased <span class=\"customMeta\" data-dictid=\"3407065fc9169277719436a1ce6d8f\">osteogenic</span> potential of the bone due to defects in local vascularisation of the bone.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Typically diagnosed in <span class=\"customMeta\" data-dictid=\"663d16ec8e169277719095f74c9816\">infancy</span> or early childhood.</li>\n<li>Affected children may present with <span class=\"customMeta\" data-dictid=\"5a5df583551692777181550518132c\">anterolateral</span> bowing of <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> and an unstable or painful area in the midshaft of the tibia.</li>\n</ul>\n<p><img alt=\"\" data-author=\"Kinderradiologie Olgahospital Klinikum Stuttgart\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Congenital_pseudarthrosis_of_the_tibia#/media/File:TP_NF.png\" data-tags=\"\" height=\"915\" src=\"https://image.prepladder.com/content/Yj93Js7Xn3qYmXt2h7qy1738001698.png\" width=\"500\"/></p>\n<ul>\n<li>There may be a noticeable lump or mass at the site of the pseudoarthrosis.</li>\n<li>Failure of the process of tubulation in early life.</li>\n<li>Cystic pre-fracture</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Standard roentgenogram: </strong>Advised as primary investigation which can show <span class=\"customMeta\" data-dictid=\"5a5df583551692777181550518132c\">anterolateral</span> bowing, <span class=\"customMeta\" data-dictid=\"bbe1b94c491692777188fe4f85b1ce\">heterogeneous</span> lesions, <span class=\"customMeta\" data-dictid=\"797daba8ca1692777197dc9f8d3a4a\">resorption</span> of the bone at the ends of fracture.</li>\n<li><strong>X-rays</strong> typically show a characteristic <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> appearance at the site of the <span class=\"customMeta\" data-dictid=\"62a73dfd591692777196c0884c3f76\">pseudoarthrosis</span> with a lack of normal bone continuity.</li>\n<li><strong>CT scans or MRI</strong> may be used for better <span class=\"customMeta\" data-dictid=\"33ba8d60fb16927772029d1067e602\">visualization</span> of the bone structure and surrounding tissues.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recurrent fractures</li>\n<li>Limb length discrepancies</li>\n<li>Valgus <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> of the ankle</li>\n<li>Tibiotarsal instability</li>\n<li>Ankle stiffness</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment options depend on the age of the child, the severity of the condition, and whether there is associated neurofibromatosis.</p>\n\t\t\t \n\n\t\t\t<ul>\n<li>Conservative treatment may include <span class=\"customMeta\" data-dictid=\"b58e8c69891692777183e7f09ab6a7\">bracing</span> or observation in mild cases.</li>\n</ul>\n<p> </p>\n<p>Surgical intervention is often required for more severe cases and may include:</p>\n<ul>\n<li><strong>Intramedullary <span class=\"customMeta\" data-dictid=\"cb2d373f701692777193324602b6fa\">nailing</span> along with bone graft</strong></li>\n<li><strong>Illizarov technique:</strong> Direct <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> of the <span class=\"customMeta\" data-dictid=\"62a73dfd591692777196c0884c3f76\">pseudoarthrosis</span> area with or without its <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> along with bone graft.</li>\n<li><strong>Vascularized bone transfers</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Differential diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Osteofibrous dysplasia</strong> of the long bones</li>\n<li>Congenital <span class=\"customMeta\" data-dictid=\"1aec9f83db16927771815b94ad8e86\">angulation</span> of the <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> bones</li>\n<li>Monostotic <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> dysplasia</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/S90qUe5iUpe0O4JXrxUp1743512972.mp3", "video": ""}, {"text": "Match the Types of Pseudoarthrosis with their Descriptions Types Description 1.Type I a) Presence of anterior bowing with an evident fracture along with pseudoarthrosis of tibia and fibula. 2. Type II b) Presence of anterior bowing along with increased cortical density and narrow medulla. 3. Type III c) Presence of anterior bowing with sclerotic bone and narrow medulla. 4. Type IV d) Presence of anterior bowing along with cyst or pre-fracture signs.", "options": [{"label": "A", "text": "1-b, 2-c, 3-d, 4-a", "correct": true}, {"label": "B", "text": "1-c, 2-b, 3-a, 4-d", "correct": false}, {"label": "C", "text": "1-a, 2-c, 3-b, 4-d", "correct": false}, {"label": "D", "text": "1-b, 2-a, 3-d, 4-c", "correct": false}], "correct_answer": "A. 1-b, 2-c, 3-d, 4-a", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:407px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type I</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> bowing along with increased <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> density and narrow medulla.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type II</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> bowing with <span class=\"customMeta\" data-dictid=\"934e9f88af169277719847f1a0728f\">sclerotic</span> bone and narrow medulla.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type III</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> bowing along with <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> or pre-fracture signs.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type IV</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> bowing with an evident <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> along with <span class=\"customMeta\" data-dictid=\"62a73dfd591692777196c0884c3f76\">pseudoarthrosis</span> of <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> and fibula.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/pM4WzeL52Q2pEMTaXzRC1743513121.mp3", "video": ""}, {"text": "Which of the following is false regarding clinical features of Madelung deformity?", "options": [{"label": "A", "text": "Mostly unilateral", "correct": true}, {"label": "B", "text": "Volar subluxation of hand", "correct": false}, {"label": "C", "text": "Prominence of distal ulna", "correct": false}, {"label": "D", "text": "Volar and ulnar angulation of distal radius", "correct": false}], "correct_answer": "A. Mostly unilateral", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Om3ao2KUY8vlyAbEyPz51738001883.png", "https://image.prepladder.com/content/lVVNwgr3nedJsYejC0e81738001936.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zEfwNOEX9bRgk1OkTSo31743577801.mp3", "video": ""}, {"text": "Which of the following diseases are associated with Madelung deformity?", "options": [{"label": "A", "text": "Turner syndrome", "correct": false}, {"label": "B", "text": "Achondroplasia", "correct": false}, {"label": "C", "text": "Mucopolysaccharidosis", "correct": false}, {"label": "D", "text": "All of the above", "correct": true}], "correct_answer": "D. All of the above", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/4f6NXyhebvOFGVrrJvkC1743578049.mp3", "video": ""}, {"text": "Which of the following is not a radiographic finding of Madelung deformity?", "options": [{"label": "A", "text": "Curved radius", "correct": false}, {"label": "B", "text": "Shorter ulna", "correct": false}, {"label": "C", "text": "Wedge-shaped carpus", "correct": false}, {"label": "D", "text": "Smaller ulnar head", "correct": true}], "correct_answer": "D. Smaller ulnar head", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/v9wMXFpioNvmxwSSZv6n1738002110.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radius</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Curved <strong>(Option A)</strong> with <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> and <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> convexity</li>\n<li>Distal <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> <span class=\"customMeta\" data-dictid=\"0fa073bd8016927771872ee5b57674\">epiphysis</span> is triangular due to failure of growth</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ulna</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dorsally subluxed.</li>\n<li>Enlarged <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> head <strong>(Option D) </strong></li>\n<li>Overall length of <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> is decreased <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Carpus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Appears subluxated towards the <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> and <span class=\"customMeta\" data-dictid=\"236c57792f1692777194be265ad6db\">palmar</span> side</li>\n<li>Wedge-shaped <strong>(Option C) </strong>with its <span class=\"customMeta\" data-dictid=\"2d7ea2751316927771816ceb31afee\">apex</span> proximal</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:588px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Conservative Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used initially for children with minimal pain and good function.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>For skeletally <span class=\"customMeta\" data-dictid=\"c219021c491692777189d289f1fc03\">immature</span> patients: <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">Distal</span> <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> <span class=\"customMeta\" data-dictid=\"d1ed4aacdf1692777194c9aa2fc2ac\">osteotomy</span> with <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> shortening (Milch resection).</li>\n<li>For skeletally <span class=\"customMeta\" data-dictid=\"0472620c171692777192c655af9c57\">mature</span> patients: <span class=\"customMeta\" data-dictid=\"d1ed4aacdf1692777194c9aa2fc2ac\">Osteotomy</span> and Darrach’s procedure.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/CBa0JxEGXeXR3GpLnWjp1743578805.mp3", "video": ""}, {"text": "Which of the following statements best describes Turco's theory of CTEV?", "options": [{"label": "A", "text": "Medial displacement of navicular and calcaneus around the talus", "correct": true}, {"label": "B", "text": "Congenital atresia of the talonavicular joint", "correct": false}, {"label": "C", "text": "Weak pronators and overacting extensors and inverters", "correct": false}, {"label": "D", "text": "Primary germplasm defect in talus with subsequent soft tissue changes", "correct": false}], "correct_answer": "A. Medial displacement of navicular and calcaneus around the talus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/KjR5rZkcVMOPKr8rudpa1738002249.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:617px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Turco's Theory</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medial <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of <span class=\"customMeta\" data-dictid=\"5b51a150cb1692777193ea9edb96b8\">navicular</span> and <span class=\"customMeta\" data-dictid=\"c8b77c76861692777183e8bcbc3c5a\">calcaneus</span> around the talus<strong> (Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Brockman's Theory</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congenital <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> of the <span class=\"customMeta\" data-dictid=\"1d4313808f1692777200ecb48a2328\">talonavicular</span> joint <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>McKay's Theory</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Three-dimensional bony <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> of the <span class=\"customMeta\" data-dictid=\"1d205eb28916927771997a96a2124f\">subtalar</span> complex</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intrauterine Theory</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Due to <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> by <span class=\"customMeta\" data-dictid=\"469a80509e169277719145248ec061\">malposition</span> of <span class=\"customMeta\" data-dictid=\"421fecf0e21692777202704942ac48\">fetus</span> in utero</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Genetic Incidence</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>General population: 1 in 800</li>\n<li>In siblings: 1 in 35</li>\n<li>In identical twins: 1 in 3</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Germ <span class=\"customMeta\" data-dictid=\"1bd96d56871692777194bee4c6107d\">Plasm</span> Theory</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primary germplasm <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in <span class=\"customMeta\" data-dictid=\"ee55b45c5f1692777200dd3dd0256a\">talus</span> with subsequent soft tissue changes <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Soft Tissue Theory</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primary soft tissue <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> with secondary bony changes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prenatal Muscle <span class=\"customMeta\" data-dictid=\"2cc844bc9c1692777189739abf1dc5\">Imbalance</span> Theory</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weak pronators and overacting extensors and inverters <strong>(Option C)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/1k0k8gc2JELltTZucQSx1743579037.mp3", "video": ""}, {"text": "Which of the following is NOT a deformity of Congenital Talipes Equinovarus?", "options": [{"label": "A", "text": "Internal tibial torsion", "correct": false}, {"label": "B", "text": "Equinus", "correct": false}, {"label": "C", "text": "Varus", "correct": false}, {"label": "D", "text": "Forefoot abduction", "correct": true}], "correct_answer": "D. Forefoot abduction", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/elHf29pFretsfdCDmUGr1738028980.png", "https://image.prepladder.com/content/01k6AdNMb8CT085TIbsS1738029044.png", "https://image.prepladder.com/content/WWVPGehAmdcJMqUoHtct1738029210.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/1iwesK20ApXdp0VkHwUu1743579946.mp3", "video": ""}, {"text": "A 7-year old boy presented as shown. What is the preferred management in this boy?", "options": [{"label": "A", "text": "Ponseti’s technique", "correct": false}, {"label": "B", "text": "Turco’s posteromedial soft tissue release", "correct": false}, {"label": "C", "text": "Dillwyn Evans procedure", "correct": true}, {"label": "D", "text": "Triple arthrodesis", "correct": false}], "correct_answer": "C. Dillwyn Evans procedure", "question_images": ["https://image.prepladder.com/content/M0Y9VpKADW20SKwSPp1B1738029322.png"], "explanation_images": ["https://image.prepladder.com/content/BC7TiuEX9sn8CPiJqQAs1738029385.png", "https://image.prepladder.com/content/joFTPeCqbk2uGlgOCVOS1738029446.png", "https://image.prepladder.com/notes/i9mxLmsHgHjjW5B14O0s1743684029.png", "https://image.prepladder.com/content/NYCBZBqBO9cocZC6mzgf1738029591.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Preferred Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>&lt;6 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ponseti technique: </strong><strong>(Option A)</strong></p>\n<ul>\n<li>Ideally to be started as soon as possible after birth</li>\n<li><strong>Correction sequence:</strong> <strong>Adduction→Varus (inversion)→Equinus</strong> (last &amp; difficult to correct)</li>\n<li>Success rate: 15-80%</li>\n<li>If success achieved,\n\t\t\t\t<ul>\n<li><strong>6-18 months:</strong> <strong>Day time Phelp’s brace</strong> &amp; <strong>Night time Dennis brown splint</strong></li>\n</ul>\n</li>\n</ul>\n<p><img alt=\"\" data-author=\"Chandrasekaran Kuppusamy, Senthil Selvam, Sandhiya Manohar, Madhumathi Kuppuraj, Sharmila Subramani, Karthikeyan Shanmugam, Jayaseelan Vijayalakshmi Kunaseelan, Manjula Subramanian\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/figure/Dennis-brown-splint_fig1_374832041\" data-tags=\"\" height=\"336\" src=\"https://image.prepladder.com/content/joFTPeCqbk2uGlgOCVOS1738029446.png\" width=\"500\"/></p>\n<ul>\n<li><strong>18 months-4 years:</strong> CTEV shoes</li>\n</ul>\n<p><img alt=\"OR798 CTEV shoes\" data-author=\"NA\" data-hash=\"7072\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" height=\"509\" src=\"https://image.prepladder.com/notes/i9mxLmsHgHjjW5B14O0s1743684029.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1-3 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Turco’s <span class=\"customMeta\" data-dictid=\"b1b0b6b9c716927771966dfdac754d\">posteromedial</span> soft tissue release</strong> <strong>(Option B)</strong></li>\n<li>McKay’s <span class=\"customMeta\" data-dictid=\"b1b0b6b9c716927771966dfdac754d\">posteromedial</span> soft tissue release</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3-5 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Dillwyn Evans</strong> procedure (resection &amp; <span class=\"customMeta\" data-dictid=\"129c645fde1692777182cf1d3e1ecc\">arthrodesis</span> of calcaneo-cuboid joint) <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>5-8 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Dwyer’s</strong> <span class=\"customMeta\" data-dictid=\"d1ed4aacdf1692777194c9aa2fc2ac\">osteotomy</span> (wedge shaped <span class=\"customMeta\" data-dictid=\"6d82ed3c231692777183a2635ae3d7\">calcaneum</span> resection)</li>\n</ul>\n<br/>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/NYCBZBqBO9cocZC6mzgf1738029591.png\" width=\"500\"/><br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>8-10 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Davis <span class=\"customMeta\" data-dictid=\"d1ed4aacdf1692777194c9aa2fc2ac\">osteotomy</span> <strong>(wedge tarsectomy)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>&gt;10 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Triple arthrodesis:</strong> <strong>Talocalcaneal-Calcaneocuboid-Talonavicular</strong> (TC-CC-TN) <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/CWyjBCuMk9XeBgz8B0UF1743580102.mp3", "video": ""}, {"text": "An X-ray of an infant is given below. Choose the correct set of true statements regarding this condition 1) More common in females 2) More common on the right side 3) Primarily due to defect in ossification of head of femur 4) Wider acetabulum is usually seen 5) Most commonly bilateral presentation is seen", "options": [{"label": "A", "text": "1,3,4", "correct": false}, {"label": "B", "text": "1,3", "correct": true}, {"label": "C", "text": "1,3,5", "correct": false}, {"label": "D", "text": "2,5", "correct": false}], "correct_answer": "B. 1,3", "question_images": ["https://image.prepladder.com/content/XDG5Iv1Eu0cqIEY9YwDr1738029681.png"], "explanation_images": ["https://image.prepladder.com/content/3qvj9vadGKxbE4dIkXlM1738029753.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:645px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Partial./complete <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of head of <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> from <span class=\"customMeta\" data-dictid=\"58112da05c1692777180028ce828fa\">acetabulum</span> since birth.</li>\n<li>Also known as Developmental <span class=\"customMeta\" data-dictid=\"984733db481692777186757cce6e6b\">dysplasia</span> of Hip (DDH)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk factors </strong></p>\n<p><strong>(5 Fs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Female babies <strong>(Statement 1)</strong></li>\n<li>First borns</li>\n<li>Full term</li>\n<li>Fair (more common in white race)</li>\n<li>Faulty <span class=\"customMeta\" data-dictid=\"1d5d2712dc169277719050154d38a1\">intrauterine</span> position (Breech, oligohydramnios)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Genetic/Familial: positive in 20% cases</li>\n<li>Hormonal: <span class=\"customMeta\" data-dictid=\"07c302047516927771976265c62a40\">Relaxin</span> causes <span class=\"customMeta\" data-dictid=\"6f158cd2c11692777191fbc6ef31ac\">laxity</span> of hip joint</li>\n<li>Mechanical: association with malpresentations</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Primary defect: Acetabular <span class=\"customMeta\" data-dictid=\"984733db481692777186757cce6e6b\">dysplasia</span> - <strong>shallow <span class=\"customMeta\" data-dictid=\"58112da05c1692777180028ce828fa\">acetabulum</span> </strong><strong>(Statement 4)</strong> and <span class=\"customMeta\" data-dictid=\"3be8c9fc131692777194e15d6aeef3\">ossification</span> <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in head of <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> epiphysis. <strong>(Statement 3)</strong></li>\n<li><strong>Bilateral: only in 10-30%</strong> cases <strong>(Statement 5)</strong></li>\n<li>More common on the <strong>Left hip </strong><strong>(Statement 2)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/CJn8hcJpABH0FOAC0wGV1743580289.mp3", "video": ""}, {"text": "You notice the clinician performing the following in an infant. What test is done and the maneuver performed to place the hip back in the previous position?", "options": [{"label": "A", "text": "Barlow’s test - Adduction", "correct": false}, {"label": "B", "text": "Barlow’s test - Abduction", "correct": false}, {"label": "C", "text": "Ortolani’s test - Adduction", "correct": false}, {"label": "D", "text": "Ortolani’s test - Abduction", "correct": true}], "correct_answer": "D. Ortolani’s test - Abduction", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cowzLhRGY9kRxT5gW9gr1738030099.png", "https://image.prepladder.com/content/e7D18JpdGM15lTG9smzQ1738030231.png", "https://image.prepladder.com/content/V7GtzFFrFld64N1xi5ce1738030266.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Barlow’s test </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Flexion + <strong>ADDuction</strong> of the hip is done.</li>\n<li><strong>Dislocates</strong> the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head from the <span class=\"customMeta\" data-dictid=\"58112da05c1692777180028ce828fa\">acetabulum</span> (indicates positive test)</li>\n<li>Barlow- BAD (ADDuction causing dislocation).</li>\n<li>Done within the first 3 days of life.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ortolani’s test </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Flexion + <strong>ABDuction</strong> of the hip is done.</li>\n<li><strong>Replaces the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head back into the acetabulum</strong> (clunk sound of entry indicates positive test)</li>\n<li>Done between 3-9 months of age.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Galleazi’s sign / Allis test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Levels of both knee joints are noted with the child in <span class=\"customMeta\" data-dictid=\"b0976ea1fd16927771995d5c700a21\">supine</span> position with both knees and hips flexed.</li>\n<li><strong>Positive test: </strong>affected knee is at a lower level (due to <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> shortening)</li>\n</ul>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/e7D18JpdGM15lTG9smzQ1738030231.png\" width=\"500\"/></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Telescopic test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>With the knee and hip both flexed at 90°, the <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> is pushed down and then lifted up.</li>\n<li><strong>Positive test: </strong>Head of <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> goes up &amp; down.</li>\n</ul>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/V7GtzFFrFld64N1xi5ce1738030266.png\" width=\"500\"/></p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infants</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Asymmetric thigh and <span class=\"customMeta\" data-dictid=\"6df580322e1692777188d0c52e5f90\">gluteal</span> folds</li>\n<li>Widened perineum</li>\n<li>Exaggerated internal <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> of hip</li>\n<li>Positive clinical tests (mentioned above)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Childhood</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Trendelenberg <span class=\"customMeta\" data-dictid=\"053afdc7031692777187c2079a86a3\">gait</span> (unilateral) / Waddling <span class=\"customMeta\" data-dictid=\"053afdc7031692777187c2079a86a3\">gait</span> (bilateral)</li>\n<li>Exaggerated <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> lordosis</li>\n<li>Unilateral/bilateral shortening of leg</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adults</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Osteoarthritis of <span class=\"customMeta\" data-dictid=\"c28d031bd31692777189aa73411316\">hip joint</span> (presents earlier than normal people)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/28YPXOgIGn6cBfpZoPQB1743580510.mp3", "video": ""}, {"text": "A 3-month old baby with persistent crying was brought to orthopedics OPD due to exaggerated internally rotated posture of hip. On examination, the perineum was wide,hip joint laxity was present and Barlow’s provocation test was positive. Temp-36 and other vitals were stable. What is the preferred management in this child?", "options": [{"label": "A", "text": "Closed reduction with hip spica", "correct": false}, {"label": "B", "text": "Open reduction with salter’s osteotomy", "correct": false}, {"label": "C", "text": "Total hip replacement", "correct": false}, {"label": "D", "text": "Pavlik harness", "correct": true}], "correct_answer": "D. Pavlik harness", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/eaaGZuTZn70mW5ksc8Ev1738030370.png", "https://image.prepladder.com/content/alzj7ojpWDvcdJiKUv2c1738030405.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation of choice</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classification used</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>&lt;6 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>USG (screening investigation)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Graf’s classification</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>&gt;6 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>MRI (diagnostic investigation)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Kashiwagi’s classification</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>&lt;6 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Von rosen <span class=\"customMeta\" data-dictid=\"7f606f911b1692777199eb69ab67c5\">splint</span> and <strong>Pavlik <span class=\"customMeta\" data-dictid=\"fb748acb9b1692777188fafdbcbbc6\">harness</span> </strong><strong>(Option D)</strong></p>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/eaaGZuTZn70mW5ksc8Ev1738030370.png\" width=\"500\"/></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>6-18 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Closed reduction with Hip <span class=\"customMeta\" data-dictid=\"f2ad4340681692777199d8bf0f5cbb\">spica</span> <strong>(Option A)</strong></p>\n<p><img alt=\"\" data-author=\"Katharina Gather, Ivan Mavrev, Simone Gantz, Thomas Dreher, Sébastien Hagmann, Nicholas Andreas Beckmann\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Shows-a-patient-in-a-spica-cast-with-hip-abduction-and-flexion_fig2_361826954\" data-tags=\"\" height=\"249\" src=\"https://image.prepladder.com/content/alzj7ojpWDvcdJiKUv2c1738030405.png\" width=\"500\"/></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>&gt;18 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Open reduction with <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> osteotomies (Salter’s/Chiari osteotomy) <strong>(Option B)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/bv5blUmfkvwwNJshcpAC1743582224.mp3", "video": ""}, {"text": "A 4-year-old child is brought to the clinic by his parents due to concerns about his bowing legs. On examination, the bowing is more pronounced on one side, and the child is overweight for his age. X-rays of the lower limbs show abrupt varus deformity and irregularity at the medial aspect of the proximal tibial metaphysis with Metaphyseal-Diaphyseal angle(MDA) &amp;gt; 11°.The child has no history of trauma or infection. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Blount Disease", "correct": true}, {"label": "B", "text": "Ollier Disease", "correct": false}, {"label": "C", "text": "Metaphyseal Chondrodysplasia", "correct": false}, {"label": "D", "text": "Physiological Bowing of Legs", "correct": false}], "correct_answer": "A. Blount Disease", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hZEWwwgGPTtXIpk5J0Hj1738030535.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infantile Blount disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adolescent Blount disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diagnosed in children between age 1-3 years.</li>\n<li>Bilateral condition.</li>\n<li>Characterised by <span class=\"customMeta\" data-dictid=\"5cdf29eaf516927772012b4a16cde1\">varus</span> <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> of <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> with identification of <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> thrust.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Emerges in children in their late childhood or early adolescent.</li>\n<li>Unilateral or <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> conditions.</li>\n<li>Characterised by pain in the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> aspect of the knee.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Angles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metaphyseal-Diaphyseal angle(MDA)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"293bd03891169277719013dbc608fd\">intersection</span> occurs between a line drawn from the most <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> point on the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> beaks of the <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> <span class=\"customMeta\" data-dictid=\"8ccb80bd4d169277719296d80e2193\">metaphysis</span> to a line perpendicular to the long <span class=\"customMeta\" data-dictid=\"3c28fd47f71692777182efbbaa5f6d\">axis</span> of the <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> diaphysis.</li>\n<li>An angle &gt;16° is associated with a 95% risk of <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> progression.</li>\n<li>An angle &lt;10° is likely physiological, with a 95% chance of <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> resolution.</li>\n<li>An angle between 11° and 16° necessitates close observation for the potential <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> vara progression.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tibiofemoral angle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Measures the severity of <span class=\"customMeta\" data-dictid=\"5cdf29eaf516927772012b4a16cde1\">varus</span> deformity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medial Metaphyseal <span class=\"customMeta\" data-dictid=\"273ed4fdf916927771827f19d7abc5\">Beak</span> angle(MMBA)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diagnostic screening tool for individual risk of blount disease.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/OBuR15GhD4R0EtVQmGR11743582449.mp3", "video": ""}, {"text": "A 7 Y/O boy presents with a limp and complains of pain in his right hip that has gradually worsened over the past few weeks. The pain is sometimes referred to his knee.There is no history of trauma.On physical examination, there is a limited range of motion, particularly in internal rotation and abduction of the hip.X-ray of the pelvis shows flattening of the femoral head with areas of sclerosis and fragmentation.What is the most likely diagnosis?", "options": [{"label": "A", "text": "Perthes disease", "correct": true}, {"label": "B", "text": "Gaucher disease", "correct": false}, {"label": "C", "text": "Meyer's dysplasia", "correct": false}, {"label": "D", "text": "Multiple epiphyseal dysplasia", "correct": false}], "correct_answer": "A. Perthes disease", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/EG4z6EeRGBM8IWBXQaF11738030657.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Idiopathic <span class=\"customMeta\" data-dictid=\"ffadabff021692777194c8ebe87262\">osteonecrosis</span> or <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> of the capital <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"0fa073bd8016927771872ee5b57674\">epiphysis</span> of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiopathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Idiopathic or <span class=\"customMeta\" data-dictid=\"4711a65634169277718737b781005d\">etiology</span> that would disrupt the <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> to <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> epiphysis.</li>\n<li>Coagulopathy and <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> use.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Includes 4 phases</strong></p>\n<ul>\n<li><strong>Necrosis</strong>: <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">Disruption</span> of the blood supply leads to <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> capital epiphysis.</li>\n<li><strong>Fragmentation</strong>: The body reabsorbs the infarcted bone.</li>\n<li><strong>Reossification</strong>: Osteoblastic activity takes over, and the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"0fa073bd8016927771872ee5b57674\">epiphysis</span> reestablishes.</li>\n<li><strong>Remodeling</strong>: The new <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head may be enlarged or flattened. It reshapes during growth.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ten percent <span class=\"customMeta\" data-dictid=\"5dda3cc2ab1692777202b3b3c65bea\">familial</span> (there is a delayed <span class=\"customMeta\" data-dictid=\"627954967a1692777183a81869cece\">bone age</span> by about 2 years)</li>\n<li>HIV (Up to 5% of <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> patients have <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> of the hip)</li>\n<li>Factor V Leiden</li>\n<li>Thrombophilias (increased clotting)</li>\n<li>Hypofibrinolysis (decreased ability to dissolve clots)</li>\n<li>Secondhand smoke exposure</li>\n<li>Low socioeconomic status</li>\n<li>Birth weight less than 2.5 kg in boys</li>\n<li>Short stature</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Limp of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> or <span class=\"customMeta\" data-dictid=\"fc73a9e10016927771905d69184c24\">insidious</span> onset, usually painless.</li>\n<li>If pain is present, it is <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> to the hip or knee.</li>\n<li>Decreased internal <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> and <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> of hip.</li>\n<li>Atrophy of thighs and buttocks.</li>\n<li>Leg length discrepancy.</li>\n<li>Antalgic <span class=\"customMeta\" data-dictid=\"053afdc7031692777187c2079a86a3\">gait</span> in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> cases</li>\n<li>Trendelenburg <span class=\"customMeta\" data-dictid=\"053afdc7031692777187c2079a86a3\">gait</span> in chronic cases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Standard <span class=\"customMeta\" data-dictid=\"c12a40cc401692777181852b507764\">anteroposterior</span> <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> and frog-leg <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> (Lauenstein) views.</li>\n<li>Bone scan or MRI</li>\n</ul>\n<br/>\n<img alt=\"\" data-author=\"Mohammad Taghi Niknejad\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/perthes-disease-19\" data-tags=\"\" height=\"433\" src=\"https://image.prepladder.com/content/EG4z6EeRGBM8IWBXQaF11738030657.png\" width=\"500\"/><br/>\n\t\t\t \n\t\t\t<p><strong>Early findings:</strong></p>\n<ul>\n<li>Widening of joint space (epiphyseal <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> hypertrophy)</li>\n<li>Changes in the epiphysis.</li>\n<li><strong>Crescent sign:</strong> <span class=\"customMeta\" data-dictid=\"70d8631e3c16927771992f8f444ab1\">Subchondral</span> <span class=\"customMeta\" data-dictid=\"17825c11c616927771979bd9b0b285\">radiolucent</span> zone of the <span class=\"customMeta\" data-dictid=\"5a5df583551692777181550518132c\">anterolateral</span> epiphysis</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Late signs:</strong></p>\n<ul>\n<li>Flattening of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head.</li>\n<li>Bone scan shows decreased <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> to the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Differential diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Transient synovitis</li>\n<li>Multiple <span class=\"customMeta\" data-dictid=\"dc486020a916927771874098596bbc\">epiphyseal</span> <span class=\"customMeta\" data-dictid=\"984733db481692777186757cce6e6b\">dysplasia</span> (MED)</li>\n<li>Spondyloepiphyseal <span class=\"customMeta\" data-dictid=\"984733db481692777186757cce6e6b\">dysplasia</span> (SED)</li>\n<li>Gaucher disease</li>\n<li>Hypothyroidism</li>\n<li>Meyer dysplasia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non operative:</strong></p>\n<ul>\n<li>Indicated for children with <span class=\"customMeta\" data-dictid=\"627954967a1692777183a81869cece\">bone age</span> less than 6 or <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"711a7039b116927771952962024d86\">pillar</span> A involvement.</li>\n<li>Activity restriction and protective weight-bearing are recommended until <span class=\"customMeta\" data-dictid=\"3be8c9fc131692777194e15d6aeef3\">ossification</span> is complete.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Operative treatment:</strong></p>\n<ul>\n<li><strong>Femoral or <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">Pelvic</span> Osteotomy</strong> indicated in children older than 8 years.</li>\n<li><strong>Valgus or Shelf Osteotomies</strong> indicated in children with hinge abduction</li>\n<li><strong>Hip Arthroscopy</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Coxa magna: Widening of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head.</li>\n<li>Coda plans: <span class=\"customMeta\" data-dictid=\"13d0edf82916927772021bfc7f9aeb\">Flattening</span> of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/93kfIIuq7NV0CHPd4uYf1743583206.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 26 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 10</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Pediatric Orthopedics-Previous Year Questions - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 10</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 10 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 5-year-old child was brought with bony deformities, as shown in the radiograph below. These could be due to a deficiency of which of the following?", "options": [{"label": "A", "text": "Vitamin A", "correct": false}, {"label": "B", "text": "Vitamin D", "correct": true}, {"label": "C", "text": "Vitamin K", "correct": false}, {"label": "D", "text": "Vitamin C", "correct": false}], "correct_answer": "B. Vitamin D", "question_images": ["https://image.prepladder.com/content/3d1FDPZwg0gMvl9bEOIt1745298987.png"], "explanation_images": ["https://image.prepladder.com/content/9Dt9avvWFe9ofl69pfMx1745299031.png", "https://image.prepladder.com/content/sGDaJtKVrjEDCM7Ootrq1745299031.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Bone disorder characterized by failure of normal mineralisation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Vitamin D deficiency: Decreased intake, <span class=\"customMeta\" data-dictid=\"819ebcc6691692777191f968d41a03\">malabsorption</span> syndromes</li>\n<li>Impaired Vitamin D metabolism: Hepatic and Renal causes</li>\n<li>Defective Phosphates absorption:\n\t\t\t\t<ul>\n<li><strong>Hypophosphataemic Rickets (X-linked dominant)</strong></li>\n<li>Fanconi syndrome</li>\n<li>Renal <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> acidosis</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Craniotabes:</strong> pin-pong ball sensation of skull bone</li>\n<li><strong>Rachitic rosary:</strong> Painless <span class=\"customMeta\" data-dictid=\"ebc4d593fd1692777196b50a4faad4\">prominence</span> of <span class=\"customMeta\" data-dictid=\"bfa9e996381692777185cdc8709772\">costochondral</span> junctions</li>\n<li><strong>Harrison sulcus:</strong> <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">horizontal</span> depression on the lower part of chest</li>\n<li>Pigeon chest: Prominent sternum</li>\n<li>Deformities: Knock knees, bow legs</li>\n<li>Muscular hypotonia</li>\n<li>Delayed <span class=\"customMeta\" data-dictid=\"17dfb015d2169277720023db8fe9e5\">teeth</span> eruption</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiographic features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Delayed appearance of epiphysis</li>\n<li>Widening of <span class=\"customMeta\" data-dictid=\"dc486020a916927771874098596bbc\">epiphyseal</span> plates</li>\n<li>Cupping of metaphysis</li>\n<li>Splaying: <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> ends of metaphyseal plates</li>\n<li>Refraction of <span class=\"customMeta\" data-dictid=\"3a5e357f5b1692777186ef94b008d8\">diaphyseal</span> cortex</li>\n<li>Deformities: Genu varum, Genu valgum, Windswept <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> (Genu varum + valgum)</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Shankar Prasad Yadav\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/ray-showing-metaphyseal-widening-cupping-fraying-and-splaying_fig2_291336461\" data-tags=\"\" height=\"404\" src=\"https://image.prepladder.com/content/sGDaJtKVrjEDCM7Ootrq1745299031.png\" width=\"519\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Medical: Vitamin D supplementation 6 Lakh IU single dose followed by 400 IU daily.</li>\n<li>Non-operative: Splints, <span class=\"customMeta\" data-dictid=\"2a73ca8f1b16927771949cec7c59cc\">orthopaedic</span> shoes</li>\n<li>Surgical: Corrective osteotomies &gt; 6 months of age</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Amongst the following, which is the most suitable combination of foot deformities typical to CTEV?", "options": [{"label": "A", "text": "Equinus, eversion, forefoot adduction, cavus.", "correct": false}, {"label": "B", "text": "Equinus, eversion, forefoot abduction, cavus.", "correct": false}, {"label": "C", "text": "Equinus, inversion, forefoot adduction, cavus.", "correct": true}, {"label": "D", "text": "Equinus, inversion, forefoot adduction, planus.", "correct": false}], "correct_answer": "C. Equinus, inversion, forefoot adduction, cavus.", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/0mHtPHr2OHZDkm0srQsU1745262110.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What will be the diagnosis of the following image of a 1-year old infant’s hand?", "options": [{"label": "A", "text": "Syndactyly", "correct": true}, {"label": "B", "text": "Symphalangism", "correct": false}, {"label": "C", "text": "Polydactyly", "correct": false}, {"label": "D", "text": "Brachydactyly", "correct": false}], "correct_answer": "A. Syndactyly", "question_images": ["https://image.prepladder.com/notes/TkJJo1rTqqvr8bBB4oCU1747914836.png"], "explanation_images": ["https://image.prepladder.com/notes/TkJJo1rTqqvr8bBB4oCU1747914836.png", "https://image.prepladder.com/notes/aejYfYNFoZ55bvR6iue01747914910.png", "https://image.prepladder.com/notes/JHvsUCwPY5kicac2lbHr1747914972.png", "https://image.prepladder.com/notes/V2TWbUcySgyoFwya1arl1747915013.png", "https://image.prepladder.com/notes/ZFt8WOuEM43u9AVdhuq61747915061.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Simple Syndactyly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Only soft tissue is fused</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complex Syndactyly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Both skin and bone are fused</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complete Syndactyly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Webbing along the entire length of affected digits</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Incomplete Syndactyly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Webbing along only part of the length of the affected digits.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complicated Syndactyly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Accessory <span class=\"customMeta\" data-dictid=\"27cd397275169277719513776c38c8\">Phalanges</span> or <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> bones involved in fusion.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><img alt=\"Syndactyly Classification\" data-author=\"\" data-hash=\"13183\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/aejYfYNFoZ55bvR6iue01747914910.png\"/></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Nonoperative Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Mild or <span class=\"customMeta\" data-dictid=\"1d993016c316927771904ccbd56fdd\">incomplete syndactyly</span> and <span class=\"customMeta\" data-dictid=\"3a5454de16169277719918f0097320\">syndactyly</span> of toes are often managed non-operatively, especially when the function is unaffected.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Operative Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Surgical Timing:</strong>\n<ul>\n<li>Performed around 12-18 months of age to reduce <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> contractures.</li>\n<li>Early surgery (around 6 months) is advised for border digits (thumb, little finger) to prevent deformity.</li>\n</ul>\n</li>\n<li><strong>Surgical Technique:</strong>\n<ul>\n<li><strong>Zigzag incisions</strong> (e.g., the <strong>Cronin technique</strong>) are used to separate digits and minimise <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> contracture.</li>\n<li>Avoid simultaneous separation of both sides of a <span class=\"customMeta\" data-dictid=\"02e6b5c95316927771867eba7818b1\">digit</span> to protect blood supply.</li>\n</ul>\n</li>\n<li>Complex Syndactyly: May require bone separation (synostosis) with techniques like closing <span class=\"customMeta\" data-dictid=\"b3c25aa68616927772025ab4ff7a11\">wedge</span> osteotomies/ amputation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 9-year-old boy who is experiencing pain, limping, and has had worsening symptoms for the past 6 months? The child seems to be in good overall health, with normal height and weight. Upon examination, there is slight muscle loss on the right side, limited ability to move the hip outwards (especially when flexed), and internal rotation is restricted due to pain.", "options": [{"label": "A", "text": "DDH (developmental dysplasia of hip)", "correct": false}, {"label": "B", "text": "Slipped capital femoral epiphysis", "correct": false}, {"label": "C", "text": "Perthes disease", "correct": true}, {"label": "D", "text": "Congenital coxa vara", "correct": false}], "correct_answer": "C. Perthes disease", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/yexetOna2xG0kkup9COm1747915147.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Idiopathic <span class=\"customMeta\" data-dictid=\"ffadabff021692777194c8ebe87262\">osteonecrosis</span> or <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> of the capital <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"0fa073bd8016927771872ee5b57674\">epiphysis</span> of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiopathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Idiopathic or <span class=\"customMeta\" data-dictid=\"4711a65634169277718737b781005d\">etiology</span> that would disrupt the <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> to <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> epiphysis.</li>\n<li>Coagulopathy and <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> use.</li>\n</ul>\n<p>Includes 4 phases</p>\n<ul>\n<li><strong>Necrosis:</strong> Disruption of the blood supply leads to <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> capital epiphysis.</li>\n<li><strong>Fragmentation:</strong> The body reabsorbs the infarcted bone.</li>\n<li><strong>Reossification:</strong> Osteoblastic activity takes over, and the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"0fa073bd8016927771872ee5b57674\">epiphysis</span> reestablishes.</li>\n<li><strong>Remodeling: </strong>The new <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head may be enlarged or flattened. It reshapes during growth.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Familial ~ 10%</li>\n<li><strong>Factor V Leiden</strong>/Thrombophilias (increased clotting)</li>\n<li>Hypofibrinolysis (decreased ability to dissolve clots)</li>\n<li>Low socioeconomic status</li>\n<li>Birth weight less than 2.5 kg in boys</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Limp of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> or <span class=\"customMeta\" data-dictid=\"fc73a9e10016927771905d69184c24\">insidious</span> onset, usually painless.</li>\n<li>If pain is present, it is <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> to the hip or knee.</li>\n<li>Decreased internal <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> and <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> of hip.</li>\n<li>Atrophy of thighs and buttocks.</li>\n<li>Limb length discrepancy.</li>\n<li>Antalgic <span class=\"customMeta\" data-dictid=\"053afdc7031692777187c2079a86a3\">gait</span> in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> cases and Trendelenburg <span class=\"customMeta\" data-dictid=\"053afdc7031692777187c2079a86a3\">gait</span> in chronic cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Standard <span class=\"customMeta\" data-dictid=\"c12a40cc401692777181852b507764\">anteroposterior</span> <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> and frog-leg <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> (Lauenstein) X-ray views.</li>\n<li>Bone scan or MRI</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"perthes disease x ray\" data-author=\"Mohammad Taghi Niknejad\" data-hash=\"13187\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/perthes-disease-19\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/yexetOna2xG0kkup9COm1747915147.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p> </p>\n<p><strong>Early findings:</strong></p>\n<ul>\n<li>Widening of joint space (epiphyseal <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> hypertrophy)</li>\n<li>Changes in the epiphysis.</li>\n<li>Crescent sign: Subchondral <span class=\"customMeta\" data-dictid=\"17825c11c616927771979bd9b0b285\">radiolucent</span> zone of the <span class=\"customMeta\" data-dictid=\"5a5df583551692777181550518132c\">anterolateral</span> epiphysis</li>\n</ul>\n<p><strong>Late signs:</strong></p>\n<ul>\n<li>Flattening of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head.</li>\n<li>Bone scan shows decreased <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> to the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non operative:</strong></p>\n<ul>\n<li>Indicated for children with <span class=\"customMeta\" data-dictid=\"627954967a1692777183a81869cece\">bone age</span> less than 6 or <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"711a7039b116927771952962024d86\">pillar</span> A involvement.</li>\n<li>Activity restriction and protective weight-bearing are recommended until <span class=\"customMeta\" data-dictid=\"3be8c9fc131692777194e15d6aeef3\">ossification</span> is complete.</li>\n</ul>\n<p><strong>Operative treatment:</strong></p>\n<ul>\n<li>Femoral or Pelvic Osteotomy indicated in children older than 8 years.</li>\n<li>Valgus or Shelf Osteotomies indicated in children with hinge abduction</li>\n<li>Hip replacement procedures: if Arthritis has developed</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The splint depicted below is", "options": [{"label": "A", "text": "Foot abduction orthosis", "correct": true}, {"label": "B", "text": "DiMeglio splint", "correct": false}, {"label": "C", "text": "Ponseti cast", "correct": false}, {"label": "D", "text": "Pirani cast", "correct": false}], "correct_answer": "A. Foot abduction orthosis", "question_images": ["https://image.prepladder.com/content/6wuOnSFABQGfmP0AhrKK1746015445.png"], "explanation_images": ["https://image.prepladder.com/content/eYbYRetvAeMb3ssyGcYx1746015506.png", "https://image.prepladder.com/content/8OBToeJmyfWL5bgzmGjX1746015507.png", "https://image.prepladder.com/content/LaYfW9BnptYow1zlReqm1746015506.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Preferred Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>&lt;6 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ponseti technique: </strong></p>\n<ul>\n<li>Ideally to be started as soon as possible after birth</li>\n<li><strong>Correction sequence:</strong> <strong>Adduction→Varus (inversion)→Equinus</strong> (last &amp; difficult to correct)</li>\n<li>Success rate: 15-80%</li>\n<li>If success achieved,\n\t\t\t\t<ul>\n<li><strong>6-18 months:</strong> <strong>Day time Phelp’s brace</strong> &amp; <strong>Night time Dennis brown splint</strong></li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Chandrasekaran Kuppusamy, Senthil Selvam, Sandhiya Manohar, Madhumathi Kuppuraj, Sharmila Subramani, Karthikeyan Shanmugam, Jayaseelan Vijayalakshmi Kunaseelan, Manjula Subramanian\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/figure/Dennis-brown-splint_fig1_374832041\" data-tags=\"\" height=\"233\" src=\"https://image.prepladder.com/content/eYbYRetvAeMb3ssyGcYx1746015506.png\" width=\"289\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>18 months-4 years:</strong> CTEV shoes</p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"259\" src=\"https://image.prepladder.com/content/8OBToeJmyfWL5bgzmGjX1746015507.png\" width=\"219\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1-3 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Turco’s <span class=\"customMeta\" data-dictid=\"b1b0b6b9c716927771966dfdac754d\">posteromedial</span> soft tissue release</strong></li>\n<li>McKay’s <span class=\"customMeta\" data-dictid=\"b1b0b6b9c716927771966dfdac754d\">posteromedial</span> soft tissue release</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>3-5 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Dillwyn Evans</strong> procedure (resection &amp; <span class=\"customMeta\" data-dictid=\"129c645fde1692777182cf1d3e1ecc\">arthrodesis</span> of calcaneo-cuboid joint)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>5-8 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Dwyer’s</strong> <span class=\"customMeta\" data-dictid=\"d1ed4aacdf1692777194c9aa2fc2ac\">osteotomy</span> (wedge shaped <span class=\"customMeta\" data-dictid=\"6d82ed3c231692777183a2635ae3d7\">calcaneum</span> resection)</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"354\" src=\"https://image.prepladder.com/content/LaYfW9BnptYow1zlReqm1746015506.png\" width=\"303\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>8-10 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Davis <span class=\"customMeta\" data-dictid=\"d1ed4aacdf1692777194c9aa2fc2ac\">osteotomy</span> <strong>(wedge tarsectomy)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>&gt;10 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Triple arthrodesis:</strong> <strong>Talocalcaneal-Calcaneocuboid-Talonavicular</strong> (TC-CC-TN)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Scoliosis screening in school children is done by?", "options": [{"label": "A", "text": "Straight leg raising test", "correct": false}, {"label": "B", "text": "Forward bending test", "correct": true}, {"label": "C", "text": "Backward bending test", "correct": false}, {"label": "D", "text": "Single leg standing test", "correct": false}], "correct_answer": "B. Forward bending test", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/72vq3H795iuMNqISeiKf1745583256.png", "https://image.prepladder.com/content/GTIypWMk6BYFwlaFkSuw1745583256.png", "https://image.prepladder.com/content/iebu719jF5JdBDbIqRUG1745583256.png", "https://image.prepladder.com/content/gg7TWgXp4qq0MVFyhU7h1747727813.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Non-structural (transient)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Structural (permanent) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Temporary <span class=\"customMeta\" data-dictid=\"4bd67d54f016927771850c953dadbc\">curvature</span> that can be corrected.<br/>\n\t\t\t\t </li>\n<li><strong>Postural scoliosis:</strong>\n<ul>\n<li>M/c type; Often seen in adolescent girls. <strong> </strong></li>\n<li>Mild leftward <span class=\"customMeta\" data-dictid=\"00ab88c6091692777185ea2685fa40\">convex</span> curve that <strong>straightens when bending forward</strong>.<br/>\n\t\t\t\t\t </li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Compensatory scoliosis:</strong>\n<ul>\n<li><strong>Develops to compensate for <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> tilt</strong> (e.g., due to hip disease or a short leg).</li>\n<li><strong>The curve disappears when the patient sits o</strong>r when the underlying issue is resolved.<br/>\n\t\t\t\t\t </li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Sciatic scoliosis:</strong>\n<ul>\n<li>Results from <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> muscle spasms, often due to a prolapsed <span class=\"customMeta\" data-dictid=\"95a8e326831692777190c5101eb835\">intervertebral</span> disc.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Involves permanent deformity.<br/>\n\t\t\t\t </li>\n<li><strong>Idiopathic scoliosis:</strong>\n<ul>\n<li>M/c structural type, can begin in infancy, childhood, or adolescence.</li>\n<li>M/c in adolescents</li>\n<li>Infantile <span class=\"customMeta\" data-dictid=\"a3e3b052331692777198750eaae63a\">scoliosis</span> may resolve or progress, while later-onset <span class=\"customMeta\" data-dictid=\"a3e3b052331692777198750eaae63a\">scoliosis</span> can lead to significant deformity, especially in the <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> region.<br/>\n\t\t\t\t\t </li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Congenital scoliosis:</strong>\n<ul>\n<li>Always associated with vertebral anomalies (e.g., hemivertebrae, block vertebrae, unsegmented bars).</li>\n<li>These curves can grow rapidly and may lead to neurological deficits. <strong> </strong></li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Paralytic scoliosis:</strong>\n<ul>\n<li>Caused by unbalanced <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> of trunk muscles, commonly due to poliomyelitis, cerebral palsy, or <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> dystrophies.<br/>\n\t\t\t\t\t </li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Other pathologies: Conditions like <strong>neurofibromatosis </strong>can cause<strong> structural <span class=\"customMeta\" data-dictid=\"a3e3b052331692777198750eaae63a\">scoliosis</span> with associated kyphosis.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:252px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Risser’s classification</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Grade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ossification of</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lateral 25%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lateral 50%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lateral 75%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lateral 100%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>V</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fusion of the ilium</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Blount Disease results from the involvement of", "options": [{"label": "A", "text": "Proximal tibia", "correct": true}, {"label": "B", "text": "Distal tibia", "correct": false}, {"label": "C", "text": "Proximal femur", "correct": false}, {"label": "D", "text": "Distal femur", "correct": false}], "correct_answer": "A. Proximal tibia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/rCIAC0VmsDzVj91Umb221746706138.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Infantile Blount disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Adolescent Blount disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Diagnosed in children between age 1-3 years.</li>\n<li>Bilateral condition.</li>\n<li>Characterised by <span class=\"customMeta\" data-dictid=\"5cdf29eaf516927772012b4a16cde1\">varus</span> <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> of <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> with identification of <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> thrust.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Emerges in children in their late childhood or early adolescent.</li>\n<li>Unilateral or <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> conditions.</li>\n<li>Characterised by pain in the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> aspect of the knee.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Angles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metaphyseal-Diaphyseal angle(MDA)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"293bd03891169277719013dbc608fd\">intersection</span> occurs between a line drawn from the most <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> point on the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> beaks of the <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> <span class=\"customMeta\" data-dictid=\"8ccb80bd4d169277719296d80e2193\">metaphysis</span> to a line perpendicular to the long <span class=\"customMeta\" data-dictid=\"3c28fd47f71692777182efbbaa5f6d\">axis</span> of the <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> diaphysis.</li>\n<li>An angle &gt;16° is associated with a 95% risk of <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> progression.</li>\n<li>An angle &lt;10° is likely physiological, with a 95% chance of <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> resolution.</li>\n<li>An angle between 11° and 16° necessitates close observation for the potential <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> vara progression.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tibiofemoral angle</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Measures the severity of <span class=\"customMeta\" data-dictid=\"5cdf29eaf516927772012b4a16cde1\">varus</span> deformity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medial Metaphyseal <span class=\"customMeta\" data-dictid=\"273ed4fdf916927771827f19d7abc5\">Beak</span> angle(MMBA)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Diagnostic screening tool for individual risk of blount disease.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents to the orthopedic OPD with a limp and limb shortening. His X-ray is given below, What is the diagnosis?", "options": [{"label": "A", "text": "Perthes", "correct": false}, {"label": "B", "text": "SCFE", "correct": false}, {"label": "C", "text": "DDH", "correct": true}, {"label": "D", "text": "Fracture neck of femur", "correct": false}], "correct_answer": "C. DDH", "question_images": ["https://image.prepladder.com/content/3vOlWlCZyGXwj51vU3CF1746706732.png"], "explanation_images": ["https://image.prepladder.com/content/4JNmQAsybzltW0T7gtaM1746706763.png", "https://image.prepladder.com/content/dJrn2JOSjQCEmaqm7WJJ1746706763.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Investigation of choice</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Classification used</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>&lt;6 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>USG (screening investigation)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Graf’s classification</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>&gt;6 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>MRI (diagnostic investigation)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Kashiwagi’s classification</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>&lt;6 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Von rosen splint</strong> and <strong>Pavlik harness</strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"444\" src=\"https://image.prepladder.com/content/4JNmQAsybzltW0T7gtaM1746706763.png\" width=\"442\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>6-18 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Closed reduction with Hip spica</p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Katharina Gather, Ivan Mavrev, Simone Gantz, Thomas Dreher, Sébastien Hagmann, Nicholas Andreas Beckmann\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Shows-a-patient-in-a-spica-cast-with-hip-abduction-and-flexion_fig2_361826954\" data-tags=\"\" height=\"382\" src=\"https://image.prepladder.com/content/dJrn2JOSjQCEmaqm7WJJ1746706763.png\" width=\"766\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>&gt;18 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Open reduction with <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> osteotomies (Salter’s/Chiari osteotomy)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-month-old baby is brought to the OPD with a deformity, as shown in the image below. Which of the following is the management recommendation?", "options": [{"label": "A", "text": "Manipulation and cast", "correct": true}, {"label": "B", "text": "Posteromedial soft tissue release", "correct": false}, {"label": "C", "text": "Triple arthrodesis", "correct": false}, {"label": "D", "text": "Evan’s procedure", "correct": false}], "correct_answer": "A. Manipulation and cast", "question_images": ["https://image.prepladder.com/content/V00UfcaN2IimSGS1RuDw1691220345.png"], "explanation_images": ["https://image.prepladder.com/content/5HsH8lAUCuGRTdvvZyoV1691220514.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"fb84ef68cf1692777191f6e12eeebe\"&gt;Manipulation&lt;/span&gt; and C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Evaluate the following statements with respect to CTEV: 50% cases are in males and are bilateral Forefoot is adducted and supinated With Ponseti technique, correction rate is upto 90% Equinus should be corrected first", "options": [{"label": "A", "text": "1, 2, 3 are correct", "correct": false}, {"label": "B", "text": "1 and 3 are correct", "correct": true}, {"label": "C", "text": "2 and 4 correct", "correct": false}, {"label": "D", "text": "1, 2, 3, 4 are correct", "correct": false}], "correct_answer": "B. 1 and 3 are correct", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B are correct - 1 and 3\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 20 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 2</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Regional Conditions-Previous Year Questions - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 2</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 2 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A patient was diagnosed with supraspinatus tendinitis. What degree of movement of the shoulder would present with pain in this patient?", "options": [{"label": "A", "text": "0-60 degrees", "correct": false}, {"label": "B", "text": "60-120 degrees", "correct": true}, {"label": "C", "text": "More than 120 degrees", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "B. 60-120 degrees", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Pain in the shoulder and upper arm during the <strong>mid-range (60-120 degrees) </strong>of gleno-humeral abduction. <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Minor <span class=\"customMeta\" data-dictid=\"1717bdb5d21692777200d45e31ceed\">tears</span> of the supraspinatus tendon</li>\n<li><strong>Supraspinatus tendinitis</strong></li>\n<li>Calcification of supraspinatus tendon</li>\n<li><strong>Subacromial bursitis</strong></li>\n<li>Fracture of the greater tuberosity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The space between the upper end of the <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> and the <span class=\"customMeta\" data-dictid=\"7ce5726fb0169277718072972038ca\">acromion</span> gets compromised, leading to the <span class=\"customMeta\" data-dictid=\"78dfa6942216927771971d0733476f\">rotator</span> <span class=\"customMeta\" data-dictid=\"074fda92471692777185c9d613a2ea\">cuff</span> <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> being pinched between the greater <span class=\"customMeta\" data-dictid=\"3292cfbbdb169277720182a7b986e4\">tuberosity</span> and the <span class=\"customMeta\" data-dictid=\"7ce5726fb0169277718072972038ca\">acromion</span> during mid-abduction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pain during mid-range of gleno-humeral abduction</li>\n<li>Tenderness at the supraspinatus <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> or <span class=\"customMeta\" data-dictid=\"e5fd8aa603169277719924d16bc34c\">subacromial</span> space</li>\n<li>Restriction of shoulder movements</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ultrasound therapy to the tender point</li>\n<li>Anti-inflammatory drugs</li>\n<li>Injection of <span class=\"customMeta\" data-dictid=\"3ad7a8484f16927771892d460daa4b\">hydrocortisone</span> into the <span class=\"customMeta\" data-dictid=\"e5fd8aa603169277719924d16bc34c\">subacromial</span> space</li>\n<li>Excision of the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> part of the acromion</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the statements below is not true regarding the condition depicted in the image?", "options": [{"label": "A", "text": "Less chances of recurrence", "correct": true}, {"label": "B", "text": "Transillumination positive", "correct": false}, {"label": "C", "text": "Can be surgically excised", "correct": false}, {"label": "D", "text": "Seen on the dorsal and volar aspects of the wrist", "correct": false}], "correct_answer": "A. Less chances of recurrence", "question_images": ["https://image.prepladder.com/content/ZWRoEbnEOGOEb23LyKNH1746078027.png"], "explanation_images": ["https://image.prepladder.com/content/FDsjcNfWTP7SfFxXG9qP1746078202.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Most common <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> of the wrist</li>\n<li>Arises from the <span class=\"customMeta\" data-dictid=\"d27f9c7a1b16927771999b1679d949\">synovial</span> fluid of joint/tendon sheath</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Most common: <strong>Dorsal &gt; <span class=\"customMeta\" data-dictid=\"8e0bd6da651692777202f38aeec153\">volar</span> aspects of wrist (Option D)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Usually seen in young adults</li>\n<li>Well-defined, cystic, <strong>non-tender</strong> swelling</li>\n<li>Smooth, <strong>fluctuant</strong> and <strong>transillumination positive (Option B)</strong></li>\n<li>Mucous containing cysts are associated with nail changes</li>\n<li>Rarely can cause <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> of <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Kulzerwi\" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://commons.wikimedia.org/wiki/File:Ueberbein2.jpg\" data-tags=\"\" height=\"388\" src=\"https://image.prepladder.com/content/FDsjcNfWTP7SfFxXG9qP1746078202.png\" width=\"458\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Asymptomatic cases do not require treatment, spontaneously undergoes regression.</li>\n<li>USG-guided <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> or <strong>Surgical excision</strong> is done in <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> cases and for <span class=\"customMeta\" data-dictid=\"ff63f91a5e16927771858327cda029\">cosmetic</span> indications <strong>(Option C)</strong></li>\n<li><strong>Recurrence - common (Option A)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 12 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 6</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Spine-Previous Year Questions - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 6</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 6 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "All of the following are indications of surgery in a patient of Potts' spine except?", "options": [{"label": "A", "text": "Doubtful diagnosis", "correct": false}, {"label": "B", "text": "Cold abscess without neurological complication", "correct": true}, {"label": "C", "text": "Drug resistant TB", "correct": false}, {"label": "D", "text": "Progressive cauda equina syndrome/conus medullaris syndrome", "correct": false}], "correct_answer": "B. Cold abscess without neurological complication", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Indications for surgery in patients without neurological complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Indications for surgery in patients with neurological complications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Progressive bone destruction despite ATT</li>\n<li>Failure to respond to conservative therapy</li>\n<li>Paravertebral <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> when it has increased in size despite medical treatment</li>\n<li><strong>Spinal <span class=\"customMeta\" data-dictid=\"acb259200b16927771908888d1377c\">instability</span> caused by destruction or collapse, destruction of two or more vertebrae, kyphosis</strong></li>\n<li>Prevention of severe <span class=\"customMeta\" data-dictid=\"67deccee6a16927771911e0dcd1c3c\">kyphosis</span> in young children with extensive <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> lesions</li>\n<li><strong>Large <span class=\"customMeta\" data-dictid=\"26866bac6f16927771940c1aedc2e4\">paraspinal</span> abscess</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>New or worsening <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">neural</span> complications or lack of improvement with conservative treatment</strong></li>\n<li>Paraplegia of rapid onset or severe paraplegia</li>\n<li>Late-onset paraplegia</li>\n<li>Neural <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> disease</li>\n<li>Painful <span class=\"customMeta\" data-dictid=\"30a0481dd9169277719423368f6884\">paraplegia</span> in elderly patients</li>\n<li>Spinal tumor syndrome (epidural <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> <span class=\"customMeta\" data-dictid=\"0617ad09441692777201a69289f441\">tuberculoma</span> without <span class=\"customMeta\" data-dictid=\"83ceeee3151692777194ec61af5c55\">osseous</span> involvement)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old man is suffering from increasing difficulty in bending forward with stiffness of the spine and reduced chest movements. A CT was performed and is shown below. What is the likely diagnosis?", "options": [{"label": "A", "text": "Ankylosing spondylitis", "correct": true}, {"label": "B", "text": "Rheumatoid arthritis", "correct": false}, {"label": "C", "text": "Reiter's syndrome", "correct": false}, {"label": "D", "text": "Fluorosis", "correct": false}], "correct_answer": "A. Ankylosing spondylitis", "question_images": ["https://image.prepladder.com/notes/SikHExBlHgt6yPwHmKji1746600969.png"], "explanation_images": ["https://image.prepladder.com/content/uCTZ3x9TpPnoQUBsjfeE1745583531.png", "https://image.prepladder.com/content/VsHiw0YpK8eHOjT9jaRn1745583531.png", "https://image.prepladder.com/content/loycH4XmWPL1Yn41hyEz1745583531.png", "https://image.prepladder.com/content/6LXWnC5sShnvZGzdI84y1745583531.png", "https://image.prepladder.com/notes/SikHExBlHgt6yPwHmKji1746600969.png", "https://image.prepladder.com/content/hmOysyHmZIbLC5EI7ayn1745583531.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:691px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Chronic <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> disease primarily affecting the <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> <span class=\"customMeta\" data-dictid=\"70f596ae8f16927771983211d9e56f\">skeleton</span> (spine and <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joints), leading to pain, stiffness, and <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> fusion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unknown; genetic (HLA-B27) and environmental factors involved. HLA-B27 is positive in 90% of cases, but not all carriers develop AS.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inflammation at entheses → Erosive changes → New bone formation → Syndesmophytes → <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">Spinal</span> <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> (ankylosis).</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"377\" src=\"https://image.prepladder.com/content/uCTZ3x9TpPnoQUBsjfeE1745583531.png\" width=\"377\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Musculoskeletal Symptoms:</strong></p>\n<ul>\n<li>Chronic low back pain (worse after inactivity, better with activity)</li>\n<li>Limited <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> mobility</li>\n<li>Enthesitis (Achilles, <span class=\"customMeta\" data-dictid=\"a7a430f3a9169277719510c13f434d\">plantar</span> fascia)</li>\n<li>Peripheral <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> (hips, shoulders, knees)</li>\n</ul>\n<p> </p>\n<p><strong>Extra-articular Symptoms:</strong></p>\n<ul>\n<li><strong>Ocular:</strong> Anterior <span class=\"customMeta\" data-dictid=\"b07d6fd6ef1692777201015472cd79\">uveitis</span> (pain, redness, photophobia)</li>\n<li><strong>Cardiovascular:</strong> Aortic regurgitation, <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> issues</li>\n<li><strong>Pulmonary: </strong>Apical fibrosis</li>\n<li><strong>Gastrointestinal:</strong> Associated with IBD</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Based on clinical features, <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> studies, and HLA-B27 gene presence. <strong>Modified New York Criteria:</strong></p>\n<p> </p>\n<p><strong>Clinical Criteria:</strong></p>\n<ul>\n<li>Low back pain &gt; 3 months (improves with exercise, not with rest)</li>\n<li>Limited <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> spine motion (sagittal/frontal planes)</li>\n<li>Reduced chest expansion (relative to age/sex)</li>\n</ul>\n<p> </p>\n<p><strong>Radiographic Criteria (X-ray):</strong></p>\n<p>Bilateral <span class=\"customMeta\" data-dictid=\"d17a3a17bc16927771988d9f2533a8\">sacroiliitis</span> (grade 2-4) or <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> <span class=\"customMeta\" data-dictid=\"d17a3a17bc16927771988d9f2533a8\">sacroiliitis</span> (grade 3-4)</p>\n<p> </p>\n<p><strong>Radiological Features:</strong></p>\n<ul>\n<li><strong>Blurring/haziness of <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joint</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Hyun Kyu Chang, Eun Hee Cho, Jeong Uk Kim, Hwan Herr\" data-hash=\"\" data-license=\"CC BY NC 3.0\" data-source=\"https://www.researchgate.net/figure/Plain-pelvis-radiograph-shows-the-obliteration-of-joint-space-in-both-sacroiliac-joints_fig3_12601898\" data-tags=\"\" height=\"194\" src=\"https://image.prepladder.com/content/VsHiw0YpK8eHOjT9jaRn1745583531.png\" width=\"346\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<ul>\n<li><strong>Juxta-articular sclerosis</strong></li>\n<li><strong>Vertical/bridging syndesmophytes</strong></li>\n<li><strong>Squaring of vertebrae</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Crespo-Rodríguez, Ana &amp; Sanz, Jesús &amp; Freites Nuñez, Dalifer &amp; Rosales, Zulema &amp; Abasolo, Lydia &amp; Arrazola, Juan.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/a-Syndesmophytes-at-the-anterosuperior-endplate-of-L3-and-L4-vertebrae-thin-arrows-and_fig2_354136900\" data-tags=\"\" height=\"455\" src=\"https://image.prepladder.com/content/loycH4XmWPL1Yn41hyEz1745583531.png\" width=\"251\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Bamboo spine</strong></li>\n<li><strong>Trolley track sign</strong></li>\n<li><strong>Dagger sign</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Gaillard F, Feger J, Niknejad M, et al.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/dagger-sign-spine\" data-tags=\"\" height=\"377\" src=\"https://image.prepladder.com/content/6LXWnC5sShnvZGzdI84y1745583531.png\" width=\"283\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<ul>\n<li><strong>Shiny corner sign/Romanus <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> </strong>(inflammatory lesions at edges of vertebrae)</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Shinny corner sign\" data-author=\"NA\" data-hash=\"12313\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/shiny-corner-sign-ankylosing-spondylitis\" data-tags=\"May2025\" height=\"519\" src=\"https://image.prepladder.com/notes/SikHExBlHgt6yPwHmKji1746600969.png\" width=\"278\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<p><strong>MRI:</strong> Early <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> of inflammation</p>\n<p> </p>\n<p><strong>Clinical Tests:</strong></p>\n<p><strong>For Sacroiliitis:</strong></p>\n<ul>\n<li>Gaenslen’s test</li>\n<li>Patrick/FABER test</li>\n<li>Figure of 4 test</li>\n<li>Pump handle test</li>\n</ul>\n<p> </p>\n<p><strong>For <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">Lumbar</span> Spine:</strong></p>\n<p><strong>Schober/ Modified Schober test</strong></p>\n<p> </p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"440\" src=\"https://image.prepladder.com/content/hmOysyHmZIbLC5EI7ayn1745583531.png\" width=\"440\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Laboratory Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>HLA-B27 positive (90% of cases)</li>\n<li>ESR, CRP: Elevated during active disease, but can be normal</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mechanical low back pain</li>\n<li>Other spondyloarthropathies (e.g., psoriatic arthritis)</li>\n<li>Degenerative disc disease</li>\n<li>Fibromyalgia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non-Pharmacological:</strong></p>\n<ul>\n<li>Physical therapy (mobility/posture exercises)</li>\n<li>Patient education on disease and exercise importance</li>\n</ul>\n<p> </p>\n<p><strong>Pharmacological:</strong></p>\n<ul>\n<li>NSAIDs (first-line for pain, stiffness)</li>\n<li>TNF inhibitors (for NSAID-resistant cases)</li>\n<li>IL-17 inhibitors (Secukinumab)</li>\n<li>Sulfasalazine (for <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> arthritis)</li>\n<li>Corticosteroids (short-term <span class=\"customMeta\" data-dictid=\"68e7440bd91692777202d8a14c33e0\">flare</span> control)</li>\n</ul>\n<p> </p>\n<p><strong>Surgical:</strong></p>\n<ul>\n<li>Hip replacement (for severe hip involvement)</li>\n<li>Spinal surgery (for severe deformities/fractures)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Spinal fractures (minimal trauma)</li>\n<li>Cardiac issues (aortic regurgitation, <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> defects)</li>\n<li>Osteoporosis leading to <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> risk</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:510px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Conditions mimicking Ankylosing Spondylitis with <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> fusion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Diffuse Idiopathic Skeletal Hyperostosis (DISH) (Forestier’s disease)</li>\n<li>Ossification of Posterior Longitudinal Ligament (OPLL)</li>\n<li>Spondylosis (Degenerative Disc Disease)</li>\n<li>Psoriatic Arthritis</li>\n<li>Enteropathic Arthritis (IBD-associated)</li>\n<li>Reactive Arthritis</li>\n<li>Rheumatoid Arthritis (RA)</li>\n<li>Juvenile Idiopathic Arthritis (JIA)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The brace shown in the given image is:", "options": [{"label": "A", "text": "Boston brace", "correct": false}, {"label": "B", "text": "Milwaukee brace", "correct": true}, {"label": "C", "text": "Taylor brace", "correct": false}, {"label": "D", "text": "ASHE brace", "correct": false}], "correct_answer": "B. Milwaukee brace", "question_images": ["https://image.prepladder.com/notes/Rj3KWo4ToLr2HY3hstx51746525385.png"], "explanation_images": ["https://image.prepladder.com/notes/Rj3KWo4ToLr2HY3hstx51746525385.png", "https://image.prepladder.com/notes/dIGFsZq6mn5GSfcMlRI41746525535.png", "https://image.prepladder.com/notes/n8md8CR8CS9GrJdn8tJP1746525561.png", "https://image.prepladder.com/notes/UOd1yWtP7Bf1JHWxR4fu1746525597.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "To which part of the vertebra are the screws fixed in spine fusion surgery?", "options": [{"label": "A", "text": "Spinous process", "correct": false}, {"label": "B", "text": "Lamina", "correct": false}, {"label": "C", "text": "Pedicle", "correct": true}, {"label": "D", "text": "Facet joint", "correct": false}], "correct_answer": "C. Pedicle", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the method of scoliosis measurement portrayed in the provided image?", "options": [{"label": "A", "text": "Cobb’s angle", "correct": true}, {"label": "B", "text": "Bohler’s angle", "correct": false}, {"label": "C", "text": "Ferguson angle", "correct": false}, {"label": "D", "text": "Baumann’s angle", "correct": false}], "correct_answer": "A. Cobb’s angle", "question_images": ["https://image.prepladder.com/notes/wi9TZfleNGna4Q0XOsRx1746444224.png"], "explanation_images": ["https://image.prepladder.com/content/04gNGaSKBnU4wd7oCUIm1745218278.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cobb’s angle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Management</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 20<strong>°</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Observation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20-60<strong>°</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bracing (Milwaukee brace)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;60<strong>°</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical management</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cobb angle <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Scoliosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bohler angle <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Calcaneum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ferguson angle <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Kyphosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Baumann angle <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elbow fracture</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Q angle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Patella</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Kite angle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CTEV (Congenital talipus equino varus)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Southwick angle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>SCFE (Slipped capital <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> epiphysis)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old woman comes to the emergency department after a road traffic accident. She was a non-restrained passenger in a car. She has pain in her neck and difficulty in neck movements. She has no associated neurological deficits. A neck collar is applied to protect the spinal cord. An X-ray of the neck is shown in the image below. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Hangman fracture", "correct": true}, {"label": "B", "text": "Jefferson's fracture", "correct": false}, {"label": "C", "text": "Clay Shveler fracture", "correct": false}, {"label": "D", "text": "Sciwora", "correct": false}], "correct_answer": "A. Hangman fracture", "question_images": ["https://image.prepladder.com/notes/nRA265H3h9XG8vIVPll81747985950.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:679px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Levine &amp; Edward Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 1</strong>: Less than 3 mm subluxation, stable</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rigid <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> collar</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 2</strong>: Greater than 4 mm subluxation, unstable</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-Less than 5 mm - Reduction in <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> and <span class=\"customMeta\" data-dictid=\"95af91681416927771887742113c38\">halo</span> <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> for 6 to 12 weeks</p>\n<p>-Greater than 5 mm - Require surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 2a</strong>: Unstable with <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> injury and <span class=\"customMeta\" data-dictid=\"777420204116927771812106969c5e\">angular</span> deformity</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Halo fixation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 3</strong>: Unstable with <span class=\"customMeta\" data-dictid=\"25d29169e3169277720246b37b93ef\">facet</span> and <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"7ba18aa5e616927771918a45051a40\">longitudinal</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> disruption</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Require surgery</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 16 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 9</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Sports Injuries-Previous Year Questions - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 9</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. 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Clinically, no bony injury was appreciated. The examiner is performing a test to assess the knee joint. Which test is this?", "options": [{"label": "A", "text": "Posterior drawer for PCL", "correct": false}, {"label": "B", "text": "Mc Murray", "correct": false}, {"label": "C", "text": "Lachman", "correct": true}, {"label": "D", "text": "Anterior drawer for ACL", "correct": false}], "correct_answer": "C. Lachman", "question_images": ["https://image.prepladder.com/content/f8BRzTDBAaw98foC8RvD1724837997.png"], "explanation_images": [], "explanation": "<p>Correct Option C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A counterforce brace is used in?", "options": [{"label": "A", "text": "Tennis elbow", "correct": true}, {"label": "B", "text": "Ankle sprain", "correct": false}, {"label": "C", "text": "Ulnar claw hand", "correct": false}, {"label": "D", "text": "Foot drop", "correct": false}], "correct_answer": "A. Tennis elbow", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Lateral <span class=\"customMeta\" data-dictid=\"46415c09ef1692777187f6fdf3b4f4\">epicondylitis</span> (Tennis elbow)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A condition characterized by pain and <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> at the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"9cdc5a92a216927771870d4b257a80\">epicondyle</span> of the <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> due to non-specific <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> at the origin of the <span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\">extensor</span> muscles of the forearm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Overuse of <span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\">extensor</span> muscles</li>\n<li>Repetitive activities (e.g., tennis, typing, using mouse)</li>\n<li>Non-specific <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> at muscle origin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pain and <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> precisely <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> to the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"9cdc5a92a216927771870d4b257a80\">epicondyle</span> of the humerus</li>\n<li>Pain aggravated by extending the wrist against resistance</li>\n<li>Normal <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> findings</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Cozen's test:</strong> Also known as the resisted wrist extension test or <span class=\"customMeta\" data-dictid=\"8459151fee1692777197d1ac765aa0\">resistive</span> <span class=\"customMeta\" data-dictid=\"bfe689a0b21692777200b9437fa418\">tennis elbow</span> test, this test involves the patient making a fist and resisting wrist extension while the examiner applies pressure. The test is positive if the patient experiences pain on the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> epicondyle.</li>\n<li><strong>Maudsley's test: </strong>This test involves the patient pronating their <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> and resisting extension of the third <span class=\"customMeta\" data-dictid=\"02e6b5c95316927771867eba7818b1\">digit</span> of their hand while the examiner stabilizes the humerus. The test is positive if the patient experiences sudden pain on the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> epicondyle.</li>\n<li><strong>Mills's test:</strong> Another common test for tennis elbow.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Initial: Analgesics, anti-inflammatory drugs</li>\n<li>If no response: Local <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> of <span class=\"customMeta\" data-dictid=\"3ad7a8484f16927771892d460daa4b\">hydrocortisone</span> at the point of maximum tenderness</li>\n<li>Physical therapy and activity modification</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A maid is playing with a child by spinning him while holding his hands. A few hours later, the child starts crying, does not use his arm, and does not let anybody touch him. What is the possible diagnosis?", "options": [{"label": "A", "text": "Pulled elbow", "correct": true}, {"label": "B", "text": "Olecranon fracture", "correct": false}, {"label": "C", "text": "Fracture head of radius", "correct": false}, {"label": "D", "text": "Elbow dislocation", "correct": false}], "correct_answer": "A. Pulled elbow", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ef83LKaYTVKuEtM6w3J41745217463.png", "https://image.prepladder.com/content/ZXfBuFlzuAnA42qypBRA1745217470.png", "https://image.prepladder.com/content/ZQvrPpddmW8MXQ5zhnYX1745217479.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pulled Elbow (also known as Nursemaid’s Elbow)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age group </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1-5 years (most common)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A sudden <span class=\"customMeta\" data-dictid=\"b88c1802e21692777190700ee5b998\">jerk</span> or pull on the arm when it is <strong>extended and pronated</strong> causes the <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head to slip out of the <span class=\"customMeta\" data-dictid=\"96f5104d6816927771816ac8dfceeb\">annular</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (radial head subluxation).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical presentation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The child holds the affected arm close to the body in a <strong>slightly flexed and pronated</strong> position, resisting movement, particularly supination.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diagnosis is usually clinical.</li>\n<li>X-ray is unnecessary unless there is suspicion of other injuries.\n\t\t\t\t<ul>\n<li>It may appear normal</li>\n<li>If visible, they can show subtle <strong>displacement of the <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head</strong>, with the possible <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> of the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> fat pad or visibility of the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> fat pad, indicating joint effusion.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduction of the <span class=\"customMeta\" data-dictid=\"e53b153fb316927771996481a3e88f\">subluxation</span> by <strong>supination and flexion</strong> or <strong>hyperpronation</strong> of the <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> typically results in immediate relief.</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the medical condition of a tennis player who is able to repeatedly and independently reduce a shoulder dislocation?", "options": [{"label": "A", "text": "Acute shoulder dislocation", "correct": false}, {"label": "B", "text": "Recurrent shoulder dislocation", "correct": true}, {"label": "C", "text": "Inferior shoulder dislocation", "correct": false}, {"label": "D", "text": "Fracture upper end humerus", "correct": false}], "correct_answer": "B. Recurrent shoulder dislocation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:649px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #999999; border-left:1px solid #999999; border-right:1px solid #999999; border-top:1px solid #999999; vertical-align:top\">\n<p><strong>Early Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:1px solid #999999; vertical-align:top\">\n<p><strong>Delayed Complications</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #999999; border-left:1px solid #999999; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Rotator <span class=\"customMeta\" data-dictid=\"074fda92471692777185c9d613a2ea\">cuff</span> tear</strong> - Common in the elderly due to degenerative changes in the tendons and less common in younger patients.</li>\n<li><strong>Axillary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> injury</strong> - Rare; Occurs with severe trauma</li>\n<li><strong>Nerve injury</strong> - The <strong>axillary nerve </strong>is most commonly affected; other nerve injuries and complete <span class=\"customMeta\" data-dictid=\"1e4db8b6ad1692777183683f42d44b\">brachial</span> <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> are rare.</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Recurrence</strong> - Most common, due to instability.</li>\n<li><strong>Joint stiffness</strong> - Results from prolonged immobility.</li>\n<li><strong>Unreduced dislocation</strong> - Due to missed or undiagnosed dislocation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25 year old Volleyball player presents to your OPD with injury to thumb,along with pain, swelling, and tenderness at the base of the thumb. On examination the thumb is in the position of abduction. Which of the following is the diagnosis of the presenting condition?", "options": [{"label": "A", "text": "Game keepers thumb", "correct": true}, {"label": "B", "text": "Bowler's thumb", "correct": false}, {"label": "C", "text": "Kaplan injury", "correct": false}, {"label": "D", "text": "Mallet finger", "correct": false}], "correct_answer": "A. Game keepers thumb", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Football player gets blow to the outer knee during match.Which structure is most commonly associated with this type of injury? Lateral lemniscus", "options": [{"label": "A", "text": "Anterior cruciate ligament", "correct": false}, {"label": "B", "text": "Medial collateral ligament", "correct": true}, {"label": "C", "text": "Posterior Cruciate ligament", "correct": false}, {"label": "D", "text": "Lateral lemniscus", "correct": false}], "correct_answer": "B. Medial collateral ligament", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the shown image", "options": [{"label": "A", "text": "Ankle knee stabilizer", "correct": false}, {"label": "B", "text": "Patella tendon bearing brace", "correct": true}, {"label": "C", "text": "Thomas splint", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "B. Patella tendon bearing brace", "question_images": ["https://image.prepladder.com/content/uT6bVa8i4A9kN0VxjFQ01747034246.png"], "explanation_images": ["https://image.prepladder.com/content/jN0tLzHqKgncmsD6aG141748153857.png", "https://image.prepladder.com/content/pBYoDa8tWguUUsfWd5aR1747034272.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the medical condition of a tennis player who is able to repeatedly and independently reduce a shoulder dislocation?", "options": [{"label": "A", "text": "Acute shoulder dislocation", "correct": false}, {"label": "B", "text": "Recurrent shoulder dislocation", "correct": true}, {"label": "C", "text": "Inferior shoulder dislocation", "correct": false}, {"label": "D", "text": "Fracture upper end humerus", "correct": false}], "correct_answer": "B. Recurrent shoulder dislocation", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Type of Shoulder Dislocation</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Anterior Dislocation</p>\n</td>\n<td>\n<p>The humeral head (upper arm bone) is displaced in front of the shoulder joint. <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> is the most common type, accounting for about 95% of all shoulder dislocations.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Posterior Dislocation</p>\n</td>\n<td>\n<p>The humeral head is displaced behind the shoulder joint. <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> is less common and often associated with high-energy trauma or seizures.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Inferior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">Dislocation</span> (Luxatio Erecta)</p>\n</td>\n<td>\n<p>The humeral head is displaced downward below the shoulder joint, causing an unusual appearance where the arm is locked in an abducted position. It is a rare <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of shoulder dislocation.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Superior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">Dislocation</span> (Reverse Shoulder Dislocation)</p>\n</td>\n<td>\n<p>The humeral head is displaced upward above the shoulder joint, usually caused by a combination of forceful muscle contractions and a fall onto an outstretched hand. Superior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> is also rare.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Multidirectional <span class=\"customMeta\" data-dictid=\"acb259200b16927771908888d1377c\">Instability</span> (MDI)</p>\n</td>\n<td>\n<p>MDI is a condition characterized by recurrent, <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> shoulder dislocations in multiple directions. It is often associated with shoulder <span class=\"customMeta\" data-dictid=\"6f158cd2c11692777191fbc6ef31ac\">laxity</span> and may require specialized treatment approaches.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Subluxation</p>\n</td>\n<td>\n<p>Subluxation refers to partial or incomplete dislocation, where the humeral head briefly slips out of the joint but returns to its normal position without requiring external intervention. It can cause pain and instability.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a 28-year-old man who has completed a half-marathon and is now experiencing pain on the front and inner side of his shin that worsens with prolonged jogging and walking? The X-ray results for his leg were normal.", "options": [{"label": "A", "text": "Jones fracture", "correct": false}, {"label": "B", "text": "Shin splint", "correct": true}, {"label": "C", "text": "Lisfranc fracture", "correct": false}, {"label": "D", "text": "Nutcracker fracture", "correct": false}], "correct_answer": "B. Shin splint", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 19 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 15</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Sports Injuries-Sports Injuries - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 15</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 15 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the following is NOT considered a secondary stabilizer of the knee?", "options": [{"label": "A", "text": "Popliteus", "correct": false}, {"label": "B", "text": "Quadriceps muscle", "correct": false}, {"label": "C", "text": "Semimembranosus", "correct": false}, {"label": "D", "text": "Posterior cruciate ligament (PCL)", "correct": true}], "correct_answer": "D. Posterior cruciate ligament (PCL)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:564px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Static Stabilizers (Primary stabilizers)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dynamic Stabilizers (Secondary stabilizers)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fibrous capsule</li>\n<li>Ligamentum patellae</li>\n<li><strong>Tibial <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> or <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> ligament</strong></li>\n<li><strong>Fibular <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> or <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> ligament</strong></li>\n<li><strong>Anterior <span class=\"customMeta\" data-dictid=\"0faa43e76516927771851bff22a1e2\">cruciate</span> ligament</strong></li>\n<li><strong>Posterior <span class=\"customMeta\" data-dictid=\"0faa43e76516927771851bff22a1e2\">cruciate</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> </strong><strong>(Option D)</strong></li>\n<li><strong>Arcuate popliteal ligament</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Quadriceps femoris <strong>(Option B ruled out)</strong></li>\n<li>Popliteus <strong>(Option A ruled out)</strong></li>\n<li>Biceps femoris</li>\n<li>Semitendinosus</li>\n<li>Semimembranosus <strong>(Option C ruled out)</strong></li>\n<li>Plantaris</li>\n<li>Gastrocnemius</li>\n<li>Sartorius</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/27OXLNlbRhD9x8Zb9Bca1743420062.mp3", "video": ""}, {"text": "A 25-year-old football player presents with severe knee pain after sustaining a twisting injury during a game. On examination, there is swelling and instability. Lachman test is positive, and the valgus stress test at 30 degrees of knee flexion reveals significant instability. Which structure is NOT injured in a clinical setting of O'Donoghue's triad?", "options": [{"label": "A", "text": "Anterior cruciate ligament (ACL)", "correct": false}, {"label": "B", "text": "Medial meniscus", "correct": false}, {"label": "C", "text": "Fibular collateral ligament (LCL)", "correct": true}, {"label": "D", "text": "Medial collateral ligament (MCL)", "correct": false}], "correct_answer": "C. Fibular collateral ligament (LCL)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/yA8kzqk080PVOMNDAaTS1738295856.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/jNEd56oDakGC2pWx4aiU1743420885.mp3", "video": ""}, {"text": "A 25-year-old male basketball player presents with knee instability following a non-contact pivoting injury. You perform the anterior drawer test with the patient’s knee flexed to 90° in the supine position, but there is minimal anterior translation of the tibia. However, the Lachman test shows increased anterior tibial translation with no firm endpoint. What is the reason behind the difference in the degree of tibial translational anteriorly between the two clinical tests?", "options": [{"label": "A", "text": "The anterior drawer test is more reliable for ACL injuries.", "correct": false}, {"label": "B", "text": "The Lachman test isolates the ACL better by minimizing hamstring influence", "correct": true}, {"label": "C", "text": "The anterior drawer test was performed incorrectly.", "correct": false}, {"label": "D", "text": "The patient likely has a partial PCL tear affecting the anterior drawer test.", "correct": false}], "correct_answer": "B. The Lachman test isolates the ACL better by minimizing hamstring influence", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zjz6KVw4fLRUdY9LDMIQ1738295978.png", "https://image.prepladder.com/content/20ipbUpDdJm7mEH5nlLX1738296015.png", "https://image.prepladder.com/content/DRIbq9SNMEdEGNQFo6id1738296084.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/4YcDYsG82ocHC1AiuUAg1745755160.mp3", "video": ""}, {"text": "A 28-year-old soccer player presents with a history of knee injury after feeling a 'pop' during a twisting motion on a slightly flexed knee while playing. He developed immediate swelling and pain in the knee. On examination, the Lachman test is positive. MRI confirms an anterior cruciate ligament (ACL) tear. Which of the following is the gold standard imaging modality for diagnosing his condition?", "options": [{"label": "A", "text": "X-ray", "correct": false}, {"label": "B", "text": "CT scan", "correct": false}, {"label": "C", "text": "MRI", "correct": true}, {"label": "D", "text": "Ultrasound", "correct": false}], "correct_answer": "C. MRI", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/scbT8HxZ37ac6CSLLxm21738296448.png", "https://image.prepladder.com/content/jTvIkLtHGE4vEDoDOiEo1738296400.png", "https://image.prepladder.com/content/F8MBOrWkPuxEzM5UTVZJ1738307041.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:473px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging Modality</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Use</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sensitivity</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detect fractures (femur, tibia)</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Ellisbjohns\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://en.wikipedia.org/wiki/Segond_fracture#/media/File:SegondFracture.JPG\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/scbT8HxZ37ac6CSLLxm21738296448.png\" width=\"449\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MRI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assess <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> injuries</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Saragadam Sridhar, Amutharaj Joyson, Prajoona Valsalan, B. Arthi, Ramkumar Sivasakthivel, S Mathu Priya, Rajendran Thavasimuthu, Yosef Asrat Waji\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Difference-between-normal-and-torn-ACL-in-MRI_fig1_358485442\" data-tags=\"\" height=\"123\" src=\"https://image.prepladder.com/content/jTvIkLtHGE4vEDoDOiEo1738296400.png\" width=\"400\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>~100%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CT </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Identify subtle fractures</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Nebojsha Nastov, Labinot Bekteshi, Andrej Nikolovski\" data-hash=\"\" data-license=\"CC BY-NC 4.0\" data-source=\"https://www.researchgate.net/figure/CT-scan-of-the-left-knee-sagittal-with-three-fragments-arrows-and-patellar-fracture_fig2_377153916\" data-tags=\"\" height=\"438\" src=\"https://image.prepladder.com/content/F8MBOrWkPuxEzM5UTVZJ1738307041.png\" width=\"400\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High for fractures</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Goal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Notes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-operative</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimize <span class=\"customMeta\" data-dictid=\"acb259200b16927771908888d1377c\">instability</span> via rehabilitation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Activity <span class=\"customMeta\" data-dictid=\"e480da93a016927771925dd2d9c43a\">modification</span> essential</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ACL Reconstruction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stabilize joint, restore kinematics</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Grafts: Hamstring/patella tendon</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stepwise Rehabilitation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Improve range, strength, proprioception</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Key for post-op recovery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Return to Sports</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gradual return after 9-12 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pivoting sports are the highest risk</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Injury Prevention Programs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduce primary/re-injury risk (e.g., <span class=\"customMeta\" data-dictid=\"624ee3cb8d1692777195f4dce9b626\">PEP</span> program)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proven effective in soccer players</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/jQm2jmchxarU8qccUCmU1743425005.mp3", "video": ""}, {"text": "A 35-year-old man presents to the emergency department after a motor vehicle collision where his knee struck the dashboard. He reports immediate pain and swelling in the knee. On examination, the posterior sag sign is positive. What is the most likely mechanism of his injury?", "options": [{"label": "A", "text": "Hyperextension of the knee", "correct": false}, {"label": "B", "text": "Direct blow to the anterior tibia", "correct": true}, {"label": "C", "text": "Twisting injury to the knee", "correct": false}, {"label": "D", "text": "Valgus stress applied to the knee", "correct": false}], "correct_answer": "B. Direct blow to the anterior tibia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wnSQa4KFrMsajMYU70fc1738296704.png", "https://image.prepladder.com/content/RXERPLSLruaThHo0Pro11738296728.png", "https://image.prepladder.com/notes/dU9IxZNDG9CAqxa9XilQ1744253116.png", "https://image.prepladder.com/content/DuaqEN2Hseaj3Q7n5jnv1738307828.png", "https://image.prepladder.com/content/OYsfDy7gKkx86yVPQHmJ1738307887.png", "https://image.prepladder.com/content/Q5RJ6dT6wjjoQbP8RuTg1738302195.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indication</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior Sag Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Observe from the side with knees at 90°, <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> resting on the couch, for <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> sag of the tibia.</p>\n<p><img alt=\"POSTERIOR SAG SIGN\" data-author=\"\" data-hash=\"8375\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/dU9IxZNDG9CAqxa9XilQ1744253116.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reliable for PCL damage.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drawer Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Shift the leg forwards and backwards with the knee at 90° and the hamstrings relaxed.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Steven T Swinford, Robert LaPrade, Lars Engebretsen, Moises Cohen, Marc Raymond Safran\" data-hash=\"\" data-license=\"CC BY-NC ND 4.0\" data-source=\"https://www.researchgate.net/figure/Anterolateral-drawer-test-with-the-patient-supine-and-knee-flexed-to-90-o-an-anteriorly_fig4_342948863\" data-tags=\"\" height=\"566\" src=\"https://image.prepladder.com/content/DuaqEN2Hseaj3Q7n5jnv1738307828.png\" width=\"500\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assesses anterior/posterior stability.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lachman Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assess <span class=\"customMeta\" data-dictid=\"c12a40cc401692777181852b507764\">anteroposterior</span> <span class=\"customMeta\" data-dictid=\"5b6a824410169277718856654be917\">glide</span> with knee flexed 15-20°.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Mak-Ham Lam, Daniel TP Fong, Patrick SH Yung, Eric PY Ho, Wood-Yee Chan and Kai-Ming Chan\" data-hash=\"\" data-license=\"CC BY-SA 2.0\" data-source=\"https://commons.wikimedia.org/wiki/File:ACLI_17.jpg\" data-tags=\"\" height=\"415\" src=\"https://image.prepladder.com/content/OYsfDy7gKkx86yVPQHmJ1738307887.png\" width=\"500\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More reliable for instability.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Quadriceps Active Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confirms <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"0faa43e76516927771851bff22a1e2\">cruciate</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> insufficiency.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/Q5RJ6dT6wjjoQbP8RuTg1738302195.png\" width=\"400\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confirms PCL insufficiency.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/p7NUxDM4B7CLyq1smFLz1743425145.mp3", "video": ""}, {"text": "A 22-year-old athlete presents with a knee injury sustained during a basketball game. He reports immediate swelling and difficulty bearing weight on the affected leg. Physical examination shows a positive Lachman test, indicating increased posterior translation of the tibia. If imaging reveals a partial tear of the PCL, what is the most appropriate management for this patient?", "options": [{"label": "A", "text": "Non-operative management with physical therapy", "correct": true}, {"label": "B", "text": "Immediate surgical reconstruction of the PCL", "correct": false}, {"label": "C", "text": "Application of a knee immobilizer and rest for 6 weeks", "correct": false}, {"label": "D", "text": "Open reduction and internal fixation of the ligament", "correct": false}], "correct_answer": "A. Non-operative management with physical therapy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/UhEmujxN2lkhGI6tLIha1738302441.png", "https://image.prepladder.com/content/P6TNQ77rEpukbJ2fkNHj1738302521.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-rays</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May show <span class=\"customMeta\" data-dictid=\"954dd74f031692777182664659765f\">avulsion</span> fractures at PCL <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> on the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> tibia; stress <span class=\"customMeta\" data-dictid=\"6fda63a90c1692777202563d33a81b\">X-rays</span> <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> translation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MRI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gold standard for PCL diagnosis; provides detailed <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> images and detects partial tears.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Chung-Yu Chen, Chen-Heng Hsu, Poyu Chen, Kuo Yao Hsu, Cheng-Pang Yang, Huan Sheu, Shih-sheng Chang, Chih-Hao Chiu\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Posterior-tibial-translation-on-the-kneeling-stress-radiograph-is-measured-as-the_fig2_379348559\" data-tags=\"\" height=\"242\" src=\"https://image.prepladder.com/content/UhEmujxN2lkhGI6tLIha1738302441.png\" width=\"500\"/></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Philipp W. Winkler, Bálint Zsidai, Nyaluma N. Wagala, Jonathan D. Hughes, Alexandra Horvath, Eric Hamrin Senorski, Kristian Samuelsson, Volker Musahl\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Sagittal-T2-weighted-magnetic-resonance-imaging-scans-of-the-posterior-cruciate-ligament_fig4_345979452\" data-tags=\"\" height=\"353\" src=\"https://image.prepladder.com/content/P6TNQ77rEpukbJ2fkNHj1738302521.png\" width=\"500\"/></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Focus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Operative </strong><strong> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Isolated PCL injuries, especially in low-demand patients.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Quadriceps strengthening, regain range of motion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Operative </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Patients with persistent instability, functional limitations, or significant bony avulsions.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PCL <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> or <span class=\"customMeta\" data-dictid=\"61e4fc8326169277719471f9c16b02\">open reduction</span> and <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> for avulsions.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/sTuXMtAP3fAVvqLCtIh11743425413.mp3", "video": ""}, {"text": "A 35-year-old man presents with knee pain and reports that he feels a \"catching\" sensation during movement after a recent sports injury. On examination, there is localized tenderness along the joint line, and he experiences difficulty fully extending the knee. Which of the following clinical features is most characteristic of a meniscal tear?", "options": [{"label": "A", "text": "Immediate swelling post-injury", "correct": false}, {"label": "B", "text": "Pain on passive extension of the knee", "correct": false}, {"label": "C", "text": "Locking of the knee during movement", "correct": true}, {"label": "D", "text": "Dislocation of the knee joint", "correct": false}], "correct_answer": "C. Locking of the knee during movement", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/mPrHjmJbwPkcNB3ODMv21738302638.png", "https://image.prepladder.com/content/jhq8DS1u8wfQBhi5IhDe1738302700.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Symptom/ Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Localized to the joint line, particularly medial; worsens with activities stressing the meniscus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Swelling</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Delayed onset, usually hours after injury; presents as effusion. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanical Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Locking:</strong> Difficulty fully extending the knee; suggests <strong>\"bucket-handle\" tear.</strong><strong> (Option C)</strong></li>\n<li><strong>Catching:</strong> Sensation of knee getting stuck, indicating loose fragment.</li>\n<li><strong>Giving Way:</strong> Knee <span class=\"customMeta\" data-dictid=\"2cdd3187321692777183fb22d77cfb\">buckling</span> during twisting movements, suggesting instability.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examination Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Tenderness:</strong> Localized along the joint line, typically medial.</li>\n<li><strong>Limited Extension:</strong> Difficulty achieving full knee extension.</li>\n<li><strong>Quadriceps Wasting:</strong> Possible in chronic cases.</li>\n<li><strong>Special Tests:</strong> Clinical tests (<strong>McMurray's, Apley's, Thessaly)</strong> assist diagnosis; MRI is the gold standard.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/4vZNabVB9uyOAPBfUrgL1743425683.mp3", "video": ""}, {"text": "A 28-year-old male presents to the clinic with knee pain following a twisting injury while playing football. On examination, the patient exhibits localized tenderness along the medial joint line, and the examiner suspects a meniscal tear. Which of the following clinical tests would provide the highest diagnostic accuracy for detecting a meniscal tear in this patient?", "options": [{"label": "A", "text": "McMurray's Test", "correct": false}, {"label": "B", "text": "Apley's Grinding Test", "correct": false}, {"label": "C", "text": "Thessaly Test", "correct": true}, {"label": "D", "text": "Apley's Distraction Test", "correct": false}], "correct_answer": "C. Thessaly Test", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/YF6zZOja2gD2BqHaVKWe1738303048.png", "https://image.prepladder.com/content/dHRt72wzHVuqCFUIXIFy1738303116.png", "https://image.prepladder.com/content/O6HFZmjfJXBqVYGbYywN1738303218.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Test Name</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Positive Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reliability</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>McMurray's Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Knee is flexed; examiner stabilizes while rotating the leg. Knee is slowly extended with maintained rotation.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"John Kiel \" data-hash=\"\" data-license=\"Open access\" data-source=\"https://wikism.org/McMurrays_Test#/media/File:Illustration_of_mcmurray_test_for_meniscus_tear.jpg\" data-tags=\"\" height=\"401\" src=\"https://image.prepladder.com/content/YF6zZOja2gD2BqHaVKWe1738303048.png\" width=\"400\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Palpable or audible click during extension.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not highly reliable; low sensitivity and specificity. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thessaly Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Patient stands on the affected leg with the knee flexed at 20 degrees; twists the body while maintaining knee flexion.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"John Kiel \" data-hash=\"\" data-license=\"Open access\" data-source=\"https://wikism.org/Thessaly_Test#/media/File:Thessaly_test_for_meniscus_tear.jpg\" data-tags=\"\" height=\"489\" src=\"https://image.prepladder.com/content/dHRt72wzHVuqCFUIXIFy1738303116.png\" width=\"400\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medial or <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> joint line pain or locking sensation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> accuracy (95%); low false-positive/negative rates. <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Apley's Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Patient lies <span class=\"customMeta\" data-dictid=\"607476ab371692777196d0cb2f13bc\">prone</span> with knee flexed at 90 degrees; the examiner applies <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> <strong>(Apley's <span class=\"customMeta\" data-dictid=\"c41ecd26ef1692777188314b57b1ff\">Grinding</span> Test)</strong> or <span class=\"customMeta\" data-dictid=\"2814d00d491692777186d379fdf9b1\">distraction</span> <strong>(Apley's <span class=\"customMeta\" data-dictid=\"2814d00d491692777186d379fdf9b1\">Distraction</span> Test)</strong> during <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> rotation.</p>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"356\" src=\"https://image.prepladder.com/content/O6HFZmjfJXBqVYGbYywN1738303218.png\" width=\"400\"/><br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pain with <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> suggests <span class=\"customMeta\" data-dictid=\"ddb3fc5499169277719282f6100904\">meniscal</span> tear; pain with <span class=\"customMeta\" data-dictid=\"2814d00d491692777186d379fdf9b1\">distraction</span> suggests <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> damage.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not specified; results depend on specific findings. <strong>(Options B &amp; D ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/lB4b0OvuuOB4ZaeLhSOO1743425847.mp3", "video": ""}, {"text": "A 25-year-old male presents with knee pain following a twisting injury while playing football. On examination, he exhibits joint line tenderness, effusion, and a limited range of motion. An MRI confirms a meniscal tear. Which of the following statements regarding the management of his condition is most accurate?", "options": [{"label": "A", "text": "Total meniscectomy is preferred to prevent future complications.", "correct": false}, {"label": "B", "text": "Conservative treatment includes immobilization and complete rest.", "correct": false}, {"label": "C", "text": "Meniscal repair is a suitable option for tears in the vascularized peripheral zone.", "correct": true}, {"label": "D", "text": "X-rays are definitive for diagnosing meniscal injuries.", "correct": false}], "correct_answer": "C. Meniscal repair is a suitable option for tears in the vascularized peripheral zone.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/nlYRlxxZKzttD5lUsC1G1738303333.png", "https://image.prepladder.com/content/v3fxNBD6RLwSVD7I3T6K1738303382.png", "https://image.prepladder.com/content/sUTmPg8vIG1hbz5ZfR5g1738303491.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conservative Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>First-line for non-locked joints</strong>; small <span class=\"customMeta\" data-dictid=\"1717bdb5d21692777200d45e31ceed\">tears</span> in <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> zone</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RICE</strong> (rest, ice, compression, elevation), NSAIDs, physical therapy focused on <span class=\"customMeta\" data-dictid=\"069cba94231692777197b41e753795\">range of motion</span> and strengthening <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Operative Treatment</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Considered when:</p>\n<p>The<strong> knee is locked</strong> due to a <strong>displaced <span class=\"customMeta\" data-dictid=\"ddb3fc5499169277719282f6100904\">meniscal</span> tear.</strong></p>\n<p><strong>Conservative treatment has failed,</strong> and mechanical symptoms (like locking or catching) continue.</p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical options include:</p>\n<p><strong>Meniscal Repair:</strong> <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">Suture</span> torn edges in <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> zone; promotes healing. <strong>(Option C)</strong></p>\n<p><strong>Partial Meniscectomy:</strong> Remove torn portion in <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> zone; preserve healthy tissue.</p>\n<p><strong>Total Meniscectomy:</strong> Generally avoided due to increased risk of joint <span class=\"customMeta\" data-dictid=\"acb259200b16927771908888d1377c\">instability</span> and osteoarthritis. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fM6TKJwE9w1uLVEd01s81743426143.mp3", "video": ""}, {"text": "A 27-year-old basketball player presents with lateral knee pain after a twisting injury during a game. Physical examination reveals a positive varus stress test. Imaging shows an isolated lateral collateral ligament (LCL) tear with a small bony avulsion. Which of the following is the most appropriate next step in management?", "options": [{"label": "A", "text": "Conservative treatment with bracing", "correct": false}, {"label": "B", "text": "Corticosteroid injection", "correct": false}, {"label": "C", "text": "Surgical repair", "correct": true}, {"label": "D", "text": "Total knee arthroplasty", "correct": false}], "correct_answer": "C. Surgical repair", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/gGfe3w14vBuCN88ZlYJ61738303629.png"], "explanation": "<p><strong>Educational Objective:</strong></p>\n<ul><li>➤ Learning objective:</li><li>➤ Injury Type Common Cause Severity Treatment Surgical Need MCL Valgus force (inward) Sprains to complete tears Partial tear/ Low grade full-thickness tears: Conservative (bracing) for partial/low-grade tears Yes, for complete tears or chronic instability. LCL Varus force (outward) Often combined with PLC injuries Isolates LCL Injury: Conservative (bracing) (Option A ruled out) Yes, for bony avulsions or PLC injuries. (Option C)</li><li>➤ Injury Type Common Cause Severity Treatment Surgical Need</li><li>➤ MCL Valgus force (inward) Sprains to complete tears Partial tear/ Low grade full-thickness tears: Conservative (bracing) for partial/low-grade tears Yes, for complete tears or chronic instability.</li><li>➤ Valgus force (inward)</li><li>➤ Valgus force (inward)</li><li>➤ Sprains to complete tears</li><li>➤ Sprains to complete tears</li><li>➤ Partial tear/ Low grade full-thickness tears: Conservative (bracing) for partial/low-grade tears</li><li>➤ Partial tear/ Low grade full-thickness tears: Conservative (bracing) for partial/low-grade tears</li><li>➤ Partial tear/ Low grade full-thickness tears:</li><li>➤ Yes, for complete tears or chronic instability.</li><li>➤ Yes, for complete tears or chronic instability.</li><li>➤ complete tears or chronic instability.</li><li>➤ LCL Varus force (outward) Often combined with PLC injuries Isolates LCL Injury: Conservative (bracing) (Option A ruled out) Yes, for bony avulsions or PLC injuries. (Option C)</li><li>➤ Varus force (outward)</li><li>➤ Varus force (outward)</li><li>➤ Often combined with PLC injuries</li><li>➤ Often combined with PLC injuries</li><li>➤ Isolates LCL Injury: Conservative (bracing) (Option A ruled out)</li><li>➤ Isolates LCL Injury: Conservative (bracing) (Option A ruled out)</li><li>➤ Isolates LCL Injury:</li><li>➤ (Option A ruled out)</li><li>➤ Yes, for bony avulsions or PLC injuries. (Option C)</li><li>➤ Yes, for bony avulsions or PLC injuries. (Option C)</li><li>➤ bony avulsions or PLC injuries.</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Injury Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Need</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MCL</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Valgus force (inward)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sprains to complete tears</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Partial tear/ Low <span class=\"customMeta\" data-dictid=\"d4ae50897e16927771884b5c46ba7d\">grade</span> full-thickness tears: </strong>Conservative (bracing) for partial/low-grade tears</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yes, for <strong>complete <span class=\"customMeta\" data-dictid=\"1717bdb5d21692777200d45e31ceed\">tears</span> or chronic instability.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>LCL</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Varus force (outward)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often combined with PLC injuries</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Isolates LCL Injury: </strong>Conservative (bracing) <strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yes, for <strong>bony avulsions or PLC injuries. </strong><strong>(Option C)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/nZDOKfCmrkLKDL0Jluqm1743426259.mp3", "video": ""}, {"text": "A 25-year-old male football player presents to the emergency department after sustaining a lateral blow to his knee during a game. He complains of immediate swelling, pain, and instability in the knee. On physical examination, there is tenderness along the medial aspect of the knee and a positive anterior drawer test. Which of the following structures is most likely involved in this type of injury?", "options": [{"label": "A", "text": "Lateral collateral ligament, anterior cruciate ligament, and lateral meniscus", "correct": false}, {"label": "B", "text": "Medial collateral ligament, anterior cruciate ligament, and medial meniscus", "correct": true}, {"label": "C", "text": "Posterior cruciate ligament, medial collateral ligament, and lateral meniscus", "correct": false}, {"label": "D", "text": "Medial collateral ligament, posterior cruciate ligament, and medial meniscus", "correct": false}], "correct_answer": "B. Medial collateral ligament, anterior cruciate ligament, and medial meniscus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/pah8p9OI6pZdeMtgOlTx1738303772.jpg"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Component Affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause of Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Result</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medial <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">Collateral</span> Ligament</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Valgus force (knee bending inward)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stretching/Tearing</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anterior <span class=\"customMeta\" data-dictid=\"0faa43e76516927771851bff22a1e2\">Cruciate</span> Ligament</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Twisting motion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rotational instability</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medial Meniscus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Twisting force (medial <span class=\"customMeta\" data-dictid=\"526b3e942016927771928828b6c34f\">meniscus</span> less mobile)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tear due to susceptibility</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5Sq5Rn6pIRUcsfzIWmLh1745755326.mp3", "video": ""}, {"text": "A patient experiences persistent shoulder pain and weakness after a fall. An MRI reveals a full-thickness rotator cuff tear. Which statement correctly describes the classification of rotator cuff tears?", "options": [{"label": "A", "text": "Full-thickness tears involve bursal side tear, within tendon substance", "correct": false}, {"label": "B", "text": "Partial-thickness tears can occur on the articular side or bursal side", "correct": true}, {"label": "C", "text": "Full-thickness tears are typically caused by overuse and repetitive stress", "correct": false}, {"label": "D", "text": "Partial-thickness tears develop gradually due to impingement", "correct": false}], "correct_answer": "B. Partial-thickness tears can occur on the articular side or bursal side", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cNtWidsfe0mg7f3fwEIy1738305268.png", "https://image.prepladder.com/content/Ht7jS8dKgIz0RFk2JzTp1738305322.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Common Causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Partial-Thickness Tears</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involve damage to some fibers of the tendon; can occur on:</p>\n<p>Bursal side (top)</p>\n<p>Articular side (bottom)</p>\n<p>Within <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> substance <strong>(Option A ruled out) </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Overuse, repetitive stress <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Full-Thickness Tears</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complete <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> of the tendon; not attached to the bone</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sudden injuries (e.g., falls), gradual development due to stress or <span class=\"customMeta\" data-dictid=\"252450ff3e16927771890a89952870\">impingement</span> <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ChUdSBxqDSbHVResIXtR1745317042.mp3", "video": ""}, {"text": "A 42-year-old woman presents with severe left shoulder pain, worsening over weeks, especially when raising her arm. Physical examination reveals weakness in arm abduction and tenderness along the acromion. She cannot maintain maximal external rotation during testing. Which clinical test is most likely to confirm a rotator cuff tear?", "options": [{"label": "A", "text": "Neer's impingement sign", "correct": false}, {"label": "B", "text": "Painful arc test", "correct": false}, {"label": "C", "text": "Lift-off test", "correct": true}, {"label": "D", "text": "Hawkins-Kennedy test", "correct": false}], "correct_answer": "C. Lift-off test", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/myIcBZU9t4WeQNxAuv3v1740290970.png", "https://image.prepladder.com/content/FYeGXz13cimJT27gSyEz1738306538.png", "https://image.prepladder.com/content/3CCfP6NlJLenSWF3yQI11738306739.png", "https://image.prepladder.com/content/r7DZTb56y3QEJVRSnrXP1738306668.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Look</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Scars or sinuses in skin, especially in the axilla</p>\n<p>Shoulder <span class=\"customMeta\" data-dictid=\"0bead1317716927771827dc3e80706\">asymmetry</span> in shape and muscle bulk</p>\n<p>Muscle <span class=\"customMeta\" data-dictid=\"9971eacaaf1692777202d2ece15a2a\">wasting</span> (deltoid, supraspinatus, infraspinatus) indicating possible nerve issues or tears</p>\n<p>Swelling in <span class=\"customMeta\" data-dictid=\"af5636ad4f1692777180f49bd0956a\">acromioclavicular</span> or <span class=\"customMeta\" data-dictid=\"2797924269169277719964d47f4864\">sternoclavicular</span> joints</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feel</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Check skin temperature (inflammation typically does not affect it)</p>\n<p>Palpate bony points (sternoclavicular joint, clavicle, <span class=\"customMeta\" data-dictid=\"af5636ad4f1692777180f49bd0956a\">acromioclavicular</span> joint)</p>\n<p>Locate <span class=\"customMeta\" data-dictid=\"52b488edaa1692777183ab570a7885\">bicipital</span> groove</p>\n<p>Assess <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> along <span class=\"customMeta\" data-dictid=\"7ce5726fb0169277718072972038ca\">acromion</span> (possible <span class=\"customMeta\" data-dictid=\"2009c4e59f16927772003b789356c7\">tendinitis</span> or tear)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Move</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Observe active movements (abduction, flexion, rotation) for <span class=\"customMeta\" data-dictid=\"73e8d27894169277719960f922b4b5\">symmetry</span> and pain</p>\n<p>Conduct <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> movements while stabilizing the scapula</p>\n<p>Assess strength of shoulder muscles (deltoid, <span class=\"customMeta\" data-dictid=\"2462a1d0cf16927771985f03ba098b\">serratus</span> anterior, <span class=\"customMeta\" data-dictid=\"afa97794e21692777195a324ffec49\">pectoralis</span> major)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Systems</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Examine the <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> spine for <span class=\"customMeta\" data-dictid=\"047f8930dd1692777197fed61e213c\">referred</span> pain</p>\n<p>Assess generalized joint laxity</p>\n<p>Conduct neurological exam for nerve involvement</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Painful <span class=\"customMeta\" data-dictid=\"2207398c591692777182d7ac096dbc\">Arc</span> </strong><strong>(Option B ruled out) </strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"J. Hermans, J. Luime, D. Meuffels, M. Reijman, D. Simel, S. Bierma-Zeinstra \" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.semanticscholar.org/paper/Does-this-patient-with-shoulder-pain-have-rotator-Hermans-Luime/5a432a9a52ed5ca858a0d26f0ec93398b536981a\" data-tags=\"\" height=\"350\" src=\"https://image.prepladder.com/content/myIcBZU9t4WeQNxAuv3v1740290970.png\" width=\"350\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pain between 60-120° active abduction, relieved by external rotation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neer’s <span class=\"customMeta\" data-dictid=\"252450ff3e16927771890a89952870\">Impingement</span> Sign </strong><strong>(Option A ruled out) </strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Nasch92\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Neer_impingement_test#/media/File:Neer_Test.jpg\" data-tags=\"\" height=\"372\" src=\"https://image.prepladder.com/content/FYeGXz13cimJT27gSyEz1738306538.png\" width=\"400\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Passive flexion, abduction, and internal <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> elicit pain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neer’s Test for <span class=\"customMeta\" data-dictid=\"252450ff3e16927771890a89952870\">Impingement</span> </strong></p>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/3CCfP6NlJLenSWF3yQI11738306739.png\" width=\"500\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Repeating the Neer’s sign post-anesthetic <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> confirms diagnosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hawkins-Kennedy Test </strong><strong>(Option D ruled out) </strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"John Kiel \" data-hash=\"\" data-license=\"Open access\" data-source=\"https://wikism.org/Hawkins_Test#/media/File:Illustration_of_hawkins_test_subacromial_impingement_rotator_cuff_tendinitis.jpg\" data-tags=\"\" height=\"378\" src=\"https://image.prepladder.com/content/r7DZTb56y3QEJVRSnrXP1738306668.png\" width=\"500\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Internal <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> with arm at 90° <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> causes <span class=\"customMeta\" data-dictid=\"5a5df583551692777181550518132c\">anterolateral</span> shoulder pain.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Supraspinatus (Empty Can Test)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weakness when resisting downward pressure on abducted arms suggests supraspinatus tear.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infraspinatus (Resisted External Rotation)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weakness during resisted external <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> indicates infraspinatus weakness.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subscapularis (Belly Press Test)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inability to press hand into <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> indicates subscapularis weakness.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infraspinatus and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> <span class=\"customMeta\" data-dictid=\"074fda92471692777185c9d613a2ea\">Cuff</span> (Lag and Drop Signs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inability to maintain external <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> suggests tears.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subscapularis (Lift-Off Test) </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inability to hold their hand away from their back indicates weakness.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Z8LcRqwVzd6NK8pDXoHk1743426876.mp3", "video": ""}, {"text": "A 62-year-old male presents with shoulder pain and limited range of motion after a fall. An X-ray is performed to evaluate for rotator cuff injuries. Which of the following findings would not typically be associated with rotator cuff injuries?", "options": [{"label": "A", "text": "Erosion and sclerosis at the greater tuberosity", "correct": false}, {"label": "B", "text": "Upward displacement of the humeral head", "correct": false}, {"label": "C", "text": "Joint space narrowing of the acromioclavicular joint", "correct": false}, {"label": "D", "text": "Presence of a well-defined calcific deposit within the deltoid muscle", "correct": true}], "correct_answer": "D. Presence of a well-defined calcific deposit within the deltoid muscle", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early <span class=\"customMeta\" data-dictid=\"074fda92471692777185c9d613a2ea\">Cuff</span> Dysfunction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Typically normal <span class=\"customMeta\" data-dictid=\"6fda63a90c1692777202563d33a81b\">X-rays</span> in initial <span class=\"customMeta\" data-dictid=\"78dfa6942216927771971d0733476f\">rotator</span> <span class=\"customMeta\" data-dictid=\"074fda92471692777185c9d613a2ea\">cuff</span> <span class=\"customMeta\" data-dictid=\"252450ff3e16927771890a89952870\">impingement</span> or <span class=\"customMeta\" data-dictid=\"2009c4e59f16927772003b789356c7\">tendinitis</span> stages.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic Tendinitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Erosion, sclerosis, or cysts</strong> at <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> on greater <span class=\"customMeta\" data-dictid=\"3292cfbbdb169277720182a7b986e4\">tuberosity</span> (thin <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> band).<strong>(Option A ruled out)</strong></li>\n<li><strong>Acromion Changes</strong>: Roughening/overgrowth at <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> edge, thinning of the acromion, upward humeral head <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> on <span class=\"customMeta\" data-dictid=\"a49829e8ef1692777183bc64f40412\">caudal</span> tilt view.</li>\n<li><strong>Acromioclavicular Osteoarthritis</strong>: Joint space narrowing, osteophytes, and <span class=\"customMeta\" data-dictid=\"70d8631e3c16927771992f8f444ab1\">subchondral</span> sclerosis, especially in older patients. <strong>(Option C ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cuff Disruption</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Upward Humeral Head Displacement</strong>: Decreased <span class=\"customMeta\" data-dictid=\"e5fd8aa603169277719924d16bc34c\">subacromial</span> space due to ineffective <span class=\"customMeta\" data-dictid=\"6694ddb1db1692777199c9a1e38bf0\">stabilization</span> from torn <span class=\"customMeta\" data-dictid=\"78dfa6942216927771971d0733476f\">rotator</span> cuff. <strong>(Option B ruled out)</strong></li>\n<li><strong>Glenohumeral Osteoarthritis</strong>: Develops from altered <span class=\"customMeta\" data-dictid=\"00c0f6c5371692777192d9df3f64b2\">mechanics</span> and <span class=\"customMeta\" data-dictid=\"acb259200b16927771908888d1377c\">instability</span> over time.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"3d9d9f347c1692777183a60d99394a\">Calcific</span> Tendinitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Calcification</strong> above greater <span class=\"customMeta\" data-dictid=\"3292cfbbdb169277720182a7b986e4\">tuberosity</span> in supraspinatus tendon, changing from well-defined to “woolly” during resorption, and may eventually resolve. <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/rUYcGDaPu84EwOO7kM2l1745755496.mp3", "video": ""}, {"text": "A 55-year-old male presents with shoulder pain and weakness after a fall. Imaging reveals a rotator cuff tear. Which of the following imaging modalities is considered the gold standard for diagnosing intra-articular shoulder pathologies, including rotator cuff tears?", "options": [{"label": "A", "text": "Ultrasound", "correct": false}, {"label": "B", "text": "X-rays", "correct": false}, {"label": "C", "text": "MR Arthroscopy (MRA", "correct": true}, {"label": "D", "text": "Computed Tomography (CT)", "correct": false}], "correct_answer": "C. MR Arthroscopy (MRA", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-rays </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Useful for identifying <strong>bony abnormalities and calcifications</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arthrography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Injects contrast into the <span class=\"customMeta\" data-dictid=\"f0cdc42a0c1692777198f54a380826\">shoulder joint</span> to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> the <span class=\"customMeta\" data-dictid=\"78dfa6942216927771971d0733476f\">rotator</span> <span class=\"customMeta\" data-dictid=\"074fda92471692777185c9d613a2ea\">cuff</span> and <span class=\"customMeta\" data-dictid=\"7649bd0f191692777188dcdf91af69\">glenoid</span> labrum; often combined with CT or MRI.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Computed <span class=\"customMeta\" data-dictid=\"8d4f2a375b1692777200f41db641bc\">Tomography</span> (CT) </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aids in <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> planning for procedures like shoulder replacement; CT <span class=\"customMeta\" data-dictid=\"cded63d9dd1692777182a10451e5cf\">arthrography</span> identifies <span class=\"customMeta\" data-dictid=\"1717bdb5d21692777200d45e31ceed\">tears</span> but is largely replaced by MRA.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ultrasound </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Real-time <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> for detecting <span class=\"customMeta\" data-dictid=\"78dfa6942216927771971d0733476f\">rotator</span> <span class=\"customMeta\" data-dictid=\"074fda92471692777185c9d613a2ea\">cuff</span> <span class=\"customMeta\" data-dictid=\"1717bdb5d21692777200d45e31ceed\">tears</span> and <span class=\"customMeta\" data-dictid=\"6b395fd7b21692777183cf78e12920\">biceps</span> <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> issues; operator-dependent for interpretation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">Resonance</span> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> (MRI) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Excellent for visualizing soft tissue structures, assessing tear size, <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> infiltration, and joint evaluation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">Resonance</span> <span class=\"customMeta\" data-dictid=\"cded63d9dd1692777182a10451e5cf\">Arthrography</span> (MRA) </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Highly sensitive for detecting labral <span class=\"customMeta\" data-dictid=\"1717bdb5d21692777200d45e31ceed\">tears</span> and partial <span class=\"customMeta\" data-dictid=\"78dfa6942216927771971d0733476f\">rotator</span> <span class=\"customMeta\" data-dictid=\"074fda92471692777185c9d613a2ea\">cuff</span> <span class=\"customMeta\" data-dictid=\"1717bdb5d21692777200d45e31ceed\">tears</span> using contrast.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arthroscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> procedure for diagnosing and treating <span class=\"customMeta\" data-dictid=\"f953c828ea16927771909cb3a51e36\">intra-articular</span> shoulder pathologies, <strong>considered the gold standard.</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:515px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rotator <span class=\"customMeta\" data-dictid=\"074fda92471692777185c9d613a2ea\">cuff</span> tears</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Includes partial or full-thickness tears.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Labral detachments</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Includes SLAP lesions.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Impingement syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Affects shoulder movement and pain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Frozen shoulder (adhesive capsulitis)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Restricted shoulder mobility.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment Option</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Activity Modification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Avoid activities that worsen pain, particularly those in the \"impingement position.\"</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Physiotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Focus on strengthening <span class=\"customMeta\" data-dictid=\"78dfa6942216927771971d0733476f\">rotator</span> <span class=\"customMeta\" data-dictid=\"074fda92471692777185c9d613a2ea\">cuff</span> muscles, scapular stability, and shoulder range of motion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>NSAIDs reduce pain/inflammation; <span class=\"customMeta\" data-dictid=\"a3e96d80e9169277718551158bbcd4\">corticosteroid</span> injections provide temporary relief.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extracorporeal Shockwave Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treats <span class=\"customMeta\" data-dictid=\"3d9d9f347c1692777183a60d99394a\">calcific</span> tendinitis; less effective than needle <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> or surgery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Needle <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">Aspiration</span> and <span class=\"customMeta\" data-dictid=\"ea6a429a6b1692777190801502ba55\">Irrigation</span> (Barbotage)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ultrasound-guided procedure to remove <span class=\"customMeta\" data-dictid=\"3d9d9f347c1692777183a60d99394a\">calcific</span> deposits; effective in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> cases.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Open Acromioplasty</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves removing part of the <span class=\"customMeta\" data-dictid=\"7ce5726fb0169277718072972038ca\">acromion</span> to reduce impingement; largely replaced by arthroscopic methods.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arthroscopic Acromioplasty</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> procedure with smaller incisions, less tissue disruption, and faster recovery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Open <span class=\"customMeta\" data-dictid=\"78dfa6942216927771971d0733476f\">Rotator</span> <span class=\"customMeta\" data-dictid=\"074fda92471692777185c9d613a2ea\">Cuff</span> Repair</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reattaches torn <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> to humerus; requires longer recovery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arthroscopic <span class=\"customMeta\" data-dictid=\"78dfa6942216927771971d0733476f\">Rotator</span> <span class=\"customMeta\" data-dictid=\"074fda92471692777185c9d613a2ea\">Cuff</span> Repair</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Minimally invasive; faster rehabilitation and less <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> pain.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biceps Tenodesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reattaches the long head of the <span class=\"customMeta\" data-dictid=\"6b395fd7b21692777183cf78e12920\">biceps</span> <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> for stability.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>SLAP <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">Lesion</span> Repair</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Arthroscopic procedure to repair superior <span class=\"customMeta\" data-dictid=\"b076435f7b1692777191b0f23c2e7e\">labrum</span> tears; may involve <span class=\"customMeta\" data-dictid=\"6b395fd7b21692777183cf78e12920\">biceps</span> tenodesis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Capsular Release (for Frozen Shoulder)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Releases contracted capsular tissue to improve range of motion.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/sGSzsSne1MutJtWerH531743427218.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 25 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Tuberculosis Of Bone And Joints-Previous Year Questions - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "What is the most likely stage of TB hip in a female with left leg shortening?", "options": [{"label": "A", "text": "Stage 1", "correct": false}, {"label": "B", "text": "Stage 2", "correct": false}, {"label": "C", "text": "Stage 3", "correct": true}, {"label": "D", "text": "Stage 4", "correct": false}], "correct_answer": "C. Stage 3", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/gCDf6y7C5KMvGTW3ll2b1747659534.png"], "explanation": "<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:171px\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:240px\">\n<p><strong>Clinical Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:213px\">\n<p><strong>X-ray findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; height:132px; vertical-align:top; width:171px\">\n<p><strong>Stage I: <span class=\"customMeta\" data-dictid=\"7d66a14e2416927771993133552ae6\">Synovitis</span> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; height:132px; vertical-align:top; width:240px\">\n<ul>\n<li>Irritable hip</li>\n<li>Increased FABER (Flexion, Abduction, External Rotation)</li>\n<li>Apparent lengthening due to FABER (Position of ease due to synovitis)</li>\n<li>Terminal movements are restricted by 25%</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; height:132px; vertical-align:top; width:213px\">\n<p>Normal or haziness of the <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> margins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:132px; vertical-align:top; width:171px\">\n<p><strong>Stage II: Early <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">Arthritis</span> (Option B)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; height:132px; vertical-align:top; width:240px\">\n<ul>\n<li>Early joint pain, stiffness</li>\n<li>Increased FADIR (Flexion, Adduction, Internal Rotation)</li>\n<li>Apparent shortening due to FADIR</li>\n<li>Gluteal and Quadriceps muscle wasting</li>\n<li>ROM restricted by 50%</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; height:132px; vertical-align:top; width:213px\">\n<p>Osteopenia and narrowing of joint space</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; height:132px; vertical-align:top; width:171px\">\n<p><strong>Stage III: Late <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">Arthritis</span> (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; height:132px; vertical-align:top; width:240px\">\n<ul>\n<li>Marked FADIR</li>\n<li>True shortening</li>\n<li>Gross restriction of movements (usually &gt;50%)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; height:132px; vertical-align:top; width:213px\">\n<p>Marked <span class=\"customMeta\" data-dictid=\"70d8631e3c16927771992f8f444ab1\">subchondral</span> <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> and destruction</p>\n</td>\n</tr>\n<tr>\n<td style=\"vertical-align:top\">\n<p><strong>Stage IV: Pathological Dislocation/severe <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> (Option D )</strong></p>\n</td>\n<td>\n<ul>\n<li>Marked FADIR</li>\n<li>Gross shortening</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Severe destruction and loss of joint space</li>\n<li>\"Wandering/traveling Acetabulum\": Pathological dislocation/subluxation due to gross destruction of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head or the superior acetabular margin.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Wandering acetabulum\" data-author=\"Oztürkmen, Yusuf &amp; Karamehmetoğlu, Mahmut &amp; Leblebici, Cem &amp; Gokce, Alper &amp; Caniklioğlu, Mustafa.\" data-hash=\"13008\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/a-This-radiograph-demonstrates-a-travelling-acetabulum-of-the-hipThe-femoral-head-is_fig3_26841474\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/gCDf6y7C5KMvGTW3ll2b1747659534.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identifying finding seen in TB knee is", "options": [{"label": "A", "text": "Reduction of joint space", "correct": true}, {"label": "B", "text": "Increase in joint space", "correct": false}, {"label": "C", "text": "Degeneration of cartilage", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Reduction of joint space", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identifying finding seen in TB knee is", "options": [{"label": "A", "text": "Reduction of joint space", "correct": true}, {"label": "B", "text": "Increase in joint space", "correct": false}, {"label": "C", "text": "Degeneration of cartilage", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Reduction of joint space", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Assertion: As Pott's spine progresses and causes neurological difficulties, decompression surgery becomes necessary. Why: Neurological abnormalities may persist even after completion of ATT.", "options": [{"label": "A", "text": "Both assertion and reason are true and the reason is the correct explanation for the assertion", "correct": false}, {"label": "B", "text": "Both assertion and reason are true, but the reason is not the correct explanation for the assertion", "correct": true}, {"label": "C", "text": "Assertion is true, but the reason is false", "correct": false}, {"label": "D", "text": "Assertion is false, but the reason is false", "correct": false}, {"label": "E", "text": "Both assertion and reason are false", "correct": false}], "correct_answer": "B. Both assertion and reason are true, but the reason is not the correct explanation for the assertion", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 14 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 11</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Tuberculosis Of Bone And Joints-Tb Of Bone - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 11</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. 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A cold abscess is suspected near the joint upon further examination and investigations. Which of the following is characteristic of this condition?", "options": [{"label": "A", "text": "Rapid destruction of cartilage by proteolytic enzymes", "correct": false}, {"label": "B", "text": "Rarely involves the ends of long bones", "correct": false}, {"label": "C", "text": "Always causes more significant systemic symptoms", "correct": false}, {"label": "D", "text": "Spreads through the hematogenous route", "correct": true}], "correct_answer": "D. Spreads through the hematogenous route", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/QOMyGNjpZJZMGHnayWRQ1744959275.mp3", "video": ""}, {"text": "A 14-year-old girl presents to the orthopedic OPD with a four-month history of left knee pain, which worsens with activity and at night. She has had episodes of low-grade fever and fatigue but denies any recent trauma. Upon physical examination, the left knee has limited range of motion and noticeable soft-tissue swelling. An image of the X-ray of the left knee joint is shown below. What is Phemister’s triad, and how does it relate to this case?", "options": [{"label": "A", "text": "A triad of symptoms indicating septic arthritis", "correct": false}, {"label": "B", "text": "A triad of radiological findings indicating tuberculous arthritis", "correct": true}, {"label": "C", "text": "A set of criteria for diagnosing osteosarcoma", "correct": false}, {"label": "D", "text": "A triad of radiological criteria for diagnosing Juvenile Idiopathic Arthritis", "correct": false}], "correct_answer": "B. A triad of radiological findings indicating tuberculous arthritis", "question_images": ["https://image.prepladder.com/content/DeMRWTyNYuV16xquU44q1737729316.png"], "explanation_images": ["https://image.prepladder.com/content/uwaX2f36DH87vXdFGtPr1737729447.png", "https://image.prepladder.com/content/WouyG3nY3kNDVpEKwLYR1737729501.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8lBQ7jUWpTJWsB4fztmN1744959735.mp3", "video": ""}, {"text": "A 32-year-old woman with right hip drug-susceptible TB has been treated with first-line anti-tubercular drugs (HRZE) for two months. She no longer has fever, and night sweats. What is the next step in the management of this patient?", "options": [{"label": "A", "text": "Discontinue therapy if symptoms have improved", "correct": false}, {"label": "B", "text": "Transition to second-line drugs", "correct": false}, {"label": "C", "text": "Continue Isoniazid and Rifampicin for four months", "correct": true}, {"label": "D", "text": "Start surgical intervention", "correct": false}], "correct_answer": "C. Continue Isoniazid and Rifampicin for four months", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:591px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug name</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dosage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications/Side effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Isoniazid (INH) (H)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bacteriostatic</p>\n<p>It inhibits <span class=\"customMeta\" data-dictid=\"97294d26a21692777184b7ddc59c4e\">cell wall</span> synthesis.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5 mg/kg/day</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hepatotoxicity</li>\n<li>Peripheral neuritis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rifampicin (R)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bactericidal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 mg/kg/day</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hepatotoxicity</li>\n<li>Red coloured urine</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pyrazinamide (Z)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bactericidal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>25 mg/kg/day</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hepatotoxicity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ethambutol (E)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bacteriostatic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15 mg/kg/day</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Optic neuritis</li>\n<li>Colour blindness</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Streptomycin (S)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bactericidal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15 mg/kg/day</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vestibular damage </li>\n<li>Nephrotoxicity</li>\n<li>Circumoral paraesthesia</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:640px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug name</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dosage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications/Side effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Para <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> <span class=\"customMeta\" data-dictid=\"fe98968dc816927771981ec425148c\">salicylic acid</span> (PAS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bacteriostatic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 gm/day</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anorexia, Nausea, Vomiting</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ethionamide</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bacteriostatic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15 mg/kg/day</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anorexia, Nausea, Vomiting</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cycloserine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bacteriostatic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 gm/day</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CNS toxicity- Headache, Tremor, Dysarthria.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/0c05dpI7k5G7Q1CEsZfQ1745758147.mp3", "video": ""}, {"text": "A 40-year-old man presents with a three-month history of progressively worsening lower back pain, night sweats, and weight loss. There is no history of trauma. On spinal examination, there is significant tenderness over the thoracolumbar spine, gibbus with limited range of motion. Imaging reveals vertebral destruction and a paravertebral cold abscess. Blood tests show an elevated ESR and CRP. Which of the following factors makes the vertebral body particularly susceptible to the spread of tuberculosis bacteria?", "options": [{"label": "A", "text": "Via the lymphatic vessels surrounding the spine", "correct": false}, {"label": "B", "text": "Through the Batson's paravertebral venous plexus", "correct": true}, {"label": "C", "text": "By direct extension from the intervertebral discs", "correct": false}, {"label": "D", "text": "Through direct pulmonary tuberculosis.", "correct": false}], "correct_answer": "B. Through the Batson's paravertebral venous plexus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/tDPL8XiLUfeUgv0vwC951737729862.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ROU7AVU2uZR6k4HwVQ3r1744962097.mp3", "video": ""}, {"text": "Which imaging modality is considered the best for assessing vertebral body destruction and sequestrum formation in Pott’s spine?", "options": [{"label": "A", "text": "Lateral X-ray", "correct": false}, {"label": "B", "text": "MRI", "correct": false}, {"label": "C", "text": "CT scan", "correct": true}, {"label": "D", "text": "Ultrasound", "correct": false}], "correct_answer": "C. CT scan", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/3TNWmegeixItLSxTMpw61737730357.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/tZkg8BBySCPXd4AHgJHr1744962490.mp3", "video": ""}, {"text": "Which of the following options would be considered an indication for surgical intervention in Pott’s spine?", "options": [{"label": "A", "text": "Large paraspinal abscess", "correct": false}, {"label": "B", "text": "Extensive vertebral destruction", "correct": false}, {"label": "C", "text": "Worsening neural complications despite conservative treatment", "correct": false}, {"label": "D", "text": "All of the above", "correct": true}], "correct_answer": "D. All of the above", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications for surgery in patients without neurological complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications for surgery in patients with neurological complications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Progressive bone destruction despite ATT</li>\n<li>Failure to respond to conservative therapy</li>\n<li>Paravertebral <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> when it has increased in size despite medical treatment</li>\n<li><strong>Spinal <span class=\"customMeta\" data-dictid=\"acb259200b16927771908888d1377c\">instability</span> caused by destruction or collapse, destruction of two or more vertebrae, kyphosis</strong></li>\n<li>Prevention of severe <span class=\"customMeta\" data-dictid=\"67deccee6a16927771911e0dcd1c3c\">kyphosis</span> in young children with extensive <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> lesions</li>\n<li><strong>Large <span class=\"customMeta\" data-dictid=\"26866bac6f16927771940c1aedc2e4\">paraspinal</span> abscess</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>New or worsening <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">neural</span> complications or lack of improvement with conservative treatment</strong></li>\n<li>Paraplegia of rapid onset or severe paraplegia</li>\n<li>Late-onset paraplegia</li>\n<li>Neural <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> disease</li>\n<li>Painful <span class=\"customMeta\" data-dictid=\"30a0481dd9169277719423368f6884\">paraplegia</span> in elderly patients</li>\n<li>Spinal tumor syndrome (epidural <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> <span class=\"customMeta\" data-dictid=\"0617ad09441692777201a69289f441\">tuberculoma</span> without <span class=\"customMeta\" data-dictid=\"83ceeee3151692777194ec61af5c55\">osseous</span> involvement)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/W5Vu5iWhj2L0fdJDTRaT1745758267.mp3", "video": ""}, {"text": "An 8-year-old girl presents with complaints of hip pain that has been progressively worsening over the last six months. She has had a noticeable loss of appetite, weight loss, and night sweats during this time. On examination, she exhibits an antalgic gait, and the X-ray image is shown below. Which stage of this condition does this patient most likely represent?", "options": [{"label": "A", "text": "Stage I", "correct": false}, {"label": "B", "text": "Stage II", "correct": false}, {"label": "C", "text": "Stage III", "correct": false}, {"label": "D", "text": "Stage IV", "correct": true}], "correct_answer": "D. Stage IV", "question_images": ["https://image.prepladder.com/content/n0ki3ulis6ko2zls1sqW1737730541.png"], "explanation_images": ["https://image.prepladder.com/notes/KHxyFVIog3NHSM7fA7Gc1743679202.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>X-ray findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage I: Synovitis</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Irritable hip</li>\n<li>Increased FABER (Flexion, Abduction, External Rotation)</li>\n<li>Apparent lengthening due to FABER (Position of ease due to synovitis)</li>\n<li>Terminal movements are restricted by 25%</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or haziness of the <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> margins</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage II: Early Arthritis</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Early joint pain, stiffness</li>\n<li>Increased FADIR (Flexion, Adduction, Internal Rotation)</li>\n<li>Apparent shortening due to FADIR</li>\n<li> </li>\n<li>Gluteal and <span class=\"customMeta\" data-dictid=\"175fd4b3061692777196c7f28a4c53\">Quadriceps</span> muscle wasting</li>\n<li>ROM restricted by 50%</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Osteopenia and narrowing of joint space</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage III: Late Arthritis</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Marked FADIR</li>\n<li>True shortening</li>\n<li>Gross restriction of movements (usually &gt;50%)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Marked <span class=\"customMeta\" data-dictid=\"70d8631e3c16927771992f8f444ab1\">subchondral</span> <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> and destruction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage IV: <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">Pathological</span> Dislocation</strong></p>\n<p><strong>/severe arthritis</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Marked FADIR</li>\n<li>Gross shortening</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe destruction and loss of joint space</li>\n<li>\"Wandering/traveling Acetabulum\": <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">Pathological</span> dislocation/subluxation due to gross destruction of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head or the superior acetabular margin.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"OR401 TB Hip\" data-author=\"Dr. Urvi Khambhati, Dr. Ruchit Shah, Dr. Aastha Bhatt and Feral Daruwala\" data-hash=\"7005\" data-license=\"NA\" data-source=\"https://www.radiologypaper.com/article/view/87/3-1-35\" data-tags=\"April2025\" height=\"167\" src=\"https://image.prepladder.com/notes/KHxyFVIog3NHSM7fA7Gc1743679202.png\" width=\"210\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ArVzHPKKzxxCCehj7RFw1744963193.mp3", "video": ""}, {"text": "A 45-year-old male patient presents with very advanced tuberculosis of the hip. He is a manual laborer and expresses a strong desire to maintain his ability to squat, which is important for his daily activities and cultural practices. Which treatment option would be best for this patient?", "options": [{"label": "A", "text": "Total Hip Replacement", "correct": false}, {"label": "B", "text": "Girdle Stone's Excision", "correct": true}, {"label": "C", "text": "Synovectomy", "correct": false}, {"label": "D", "text": "Mobilization exercises", "correct": false}], "correct_answer": "B. Girdle Stone's Excision", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage of Synovitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>ATT</li>\n<li>Traction\n\t\t\t\t<ul>\n<li>Relieves muscle spasm</li>\n<li>Gives rest to joint</li>\n<li>Prevents deformity</li>\n<li>Maintains joint space</li>\n</ul>\n</li>\n<li>Rest and <span class=\"customMeta\" data-dictid=\"d28ae9e5a61692777192a311363090\">mobilization</span> exercises <strong>(Option D)</strong></li>\n</ul>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage of Arthritis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>ATT</li>\n<li>Non weight <span class=\"customMeta\" data-dictid=\"2bb6ddacfd169277718230a816b21f\">bearing</span> ROM exercises.</li>\n<li>If unresponsive, then\n\t\t\t\t<ul>\n<li>Synovectomy (Removal of synovium) <strong>(Option C)</strong></li>\n<li>Joint debridement</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage of <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">Pathological</span> Dislocation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Girdle stone's <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">Excision</span> Arthroplasty<strong> (Option B)</strong>\n<ul>\n<li>Provide a painless, mobile but unstable joint</li>\n<li>Hip becomes unstable and the limb short</li>\n<li>Patient will be able to squat on the floor</li>\n<li>Preferred in countries where <span class=\"customMeta\" data-dictid=\"50bf7d28eb1692777199ceb59e36cb\">squatting</span> is important(e.g. India)</li>\n</ul>\n</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li>Total hip replacement\n\t\t\t\t<ul>\n<li>A more costly option but provides stability and functionality. <strong>(Option A)</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zu11UkS75cwPadt2XR2G1744963320.mp3", "video": ""}, {"text": "Which of the following is NOT a typical feature of the triple deformity in tuberculosis of the knee?", "options": [{"label": "A", "text": "Flexion of the knee", "correct": false}, {"label": "B", "text": "Lateral displacement of the patella", "correct": true}, {"label": "C", "text": "External rotation of the tibia", "correct": false}, {"label": "D", "text": "Posterior subluxation of the tibia", "correct": false}], "correct_answer": "B. Lateral displacement of the patella", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/a42T9vecfqHlndbmTEp21737730802.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:700px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1. Synovitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Boggy swelling</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2. Early Arthritis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe pain and swelling.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3. Late Arthritis/Pathological dislocation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Triple <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> <strong>(Options A, C, and D)</strong>\n<ul>\n<li>Posterior <span class=\"customMeta\" data-dictid=\"e53b153fb316927771996481a3e88f\">subluxation</span> of the <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> (due to <span class=\"customMeta\" data-dictid=\"6f158cd2c11692777191fbc6ef31ac\">laxity</span> of the capsule)</li>\n<li>External or <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> of the <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> (due to <span class=\"customMeta\" data-dictid=\"0338b655da16927771984b872baabb\">spasm</span> of the <span class=\"customMeta\" data-dictid=\"4c52e41aa91692777189b7b8847c4f\">iliotibial</span> band)</li>\n<li>Flexion of the knee (due to spasms of the hamstrings)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ORhTlNaTt9mroHm37gMM1744963839.mp3", "video": ""}, {"text": "A 5-year-old girl presents with a painless, progressive swelling of the middle phalanx of her left index finger for 3 months. Physical examination reveals a firm, fusiform swelling with restricted movement. X-rays show a cystic lesion in the phalanx. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Acute osteomyelitis", "correct": false}, {"label": "B", "text": "Gout", "correct": false}, {"label": "C", "text": "Tubercular dactylitis", "correct": true}, {"label": "D", "text": "Enchondroma", "correct": false}], "correct_answer": "C. Tubercular dactylitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/FIwtqWtBvEyfS09PLaTG1737730937.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TB dactylitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Also called <span class=\"customMeta\" data-dictid=\"78d32c50611692777199c6c6b9b525\">spina</span> ventosa- Painless spindle-shaped fingers</li>\n<li>Dactylitis is the <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> of <span class=\"customMeta\" data-dictid=\"27cd397275169277719513776c38c8\">phalanges</span> and metacarpals</li>\n<li>Dactylitis is primarily caused by TB</li>\n<li>Syphilis can also cause Dactylitis</li>\n</ul>\n<p><img alt=\"\" data-author=\" Quadrat-A-Eahsan Ullah, Mohammad Abdul Quader \" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.ejmed.org/index.php/ejmed/article/view/1933\" data-tags=\"\" height=\"386\" src=\"https://image.prepladder.com/content/FIwtqWtBvEyfS09PLaTG1737730937.png\" width=\"500\"/></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>BCG osteomyelitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Develops when <span class=\"customMeta\" data-dictid=\"de8b4033c51692777190aaeca3d6bc\">intradermal</span> <span class=\"customMeta\" data-dictid=\"0743ea5899169277718278d7bc17ba\">BCG</span> vaccine hits the bone</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Poncet's Arthritis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is <span class=\"customMeta\" data-dictid=\"a50c41365a1692777201501cb6b378\">tuberculous</span> <span class=\"customMeta\" data-dictid=\"943744d33e1692777196a18ed1b73c\">polyarthritis</span> resembling <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">rheumatoid</span> arthritis.</li>\n<li>Usually, large joints are involved in skeletal TB (Spine, hip, knee)</li>\n<li>But in this case, small joints are involved as that of <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">rheumatoid</span> arthritis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TB Shoulder</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The common variety is the dry type and is called <strong>caries sicca</strong></li>\n<li>There is no <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> into the joint (non-exudative)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/SxmSirZAblZjmfdMMXfG1744963943.mp3", "video": ""}, {"text": "A known healed case of TB spine presents with lower limb neurological symptoms with bowel and bladder involvement. What can be the most likely cause?", "options": [{"label": "A", "text": "Granulation tissue", "correct": false}, {"label": "B", "text": "Abscess", "correct": false}, {"label": "C", "text": "Angular kyphosis", "correct": true}, {"label": "D", "text": "Vascular thrombosis", "correct": false}], "correct_answer": "C. Angular kyphosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early-onset <span class=\"customMeta\" data-dictid=\"30a0481dd9169277719423368f6884\">paraplegia</span> Etiology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inflammatory causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Abscess – commonest <strong>(Option B)</strong></li>\n<li>Granulation tissue<strong> </strong><strong>(Option A)</strong></li>\n<li>Circumscribed <span class=\"customMeta\" data-dictid=\"a50c41365a1692777201501cb6b378\">tuberculous</span> focus</li>\n<li>Posterior <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> disease</li>\n<li>Infective <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> of the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> blood supply <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanical causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sequestrum in the canal</li>\n<li>Infected degenerated disc in the canal</li>\n<li>Pathological <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> - a ridge of bone pressing on the cord</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Late-onset <span class=\"customMeta\" data-dictid=\"30a0481dd9169277719423368f6884\">paraplegia</span> Etiology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recurrence of the disease</li>\n<li>Prominent <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> wall of the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> in case of severe <span class=\"customMeta\" data-dictid=\"67deccee6a16927771911e0dcd1c3c\">kyphosis</span> (Internal gibbus)</li>\n<li>Angular kyphosis</li>\n<li>Fibrous septae following healing</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/VafQxnvr8CSIWFlve9Eq1744964237.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 21 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 56</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Upper Limb Traumatology-Previous Year Questions - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 56</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 56 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 6-year-old child complaining of pain and swelling is suspected with supracondylar fracture of right hand (Undisplaced). X-ray of right elbow was not significant. What is the next best step in this case?", "options": [{"label": "A", "text": "Compare with X-ray of left hand", "correct": false}, {"label": "B", "text": "Immobilisation and above the elbow plaster slab (90 degree flexion)", "correct": true}, {"label": "C", "text": "Closed reduction with K wire fixation Cast", "correct": false}, {"label": "D", "text": "Cast", "correct": false}], "correct_answer": "B. Immobilisation and above the elbow plaster slab (90 degree flexion)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of displacement is most likely observed in a 60-year-old female patient who presents with pain and swelling in her left wrist after falling on an outstretched hand, and exhibits a dinner fork deformity upon examination?", "options": [{"label": "A", "text": "Proximal and ventral displacement of radius", "correct": false}, {"label": "B", "text": "Supination and dorsal displacement of radius", "correct": true}, {"label": "C", "text": "Proximal and dorsal displacement of ulna", "correct": false}, {"label": "D", "text": "Proximal and ventral displacement of ulna", "correct": false}], "correct_answer": "B. Supination and dorsal displacement of radius", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/dBYwBJUbNUvOcugiZhUM1746178476.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which nerve is most likely to be damaged in cases of anterior shoulder dislocation?", "options": [{"label": "A", "text": "Axillary nerve", "correct": true}, {"label": "B", "text": "Median nerve", "correct": false}, {"label": "C", "text": "Radial nerve", "correct": false}, {"label": "D", "text": "Suprascapular nerve", "correct": false}], "correct_answer": "A. Axillary nerve", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following fractures with their respective sites. A. Jones fracture B. Bennett's fracture C. March fracture D. Boxer fracture 1. 5th metatarsal 2. 2nd metatarsal 3. 1st metacarpal 4. 5th metacarpal", "options": [{"label": "A", "text": "A-1, B-3, C-2, D-4", "correct": true}, {"label": "B", "text": "A-2, B-3, C-1, D-4", "correct": false}, {"label": "C", "text": "A-4, B-2, C-4, D-3", "correct": false}, {"label": "D", "text": "A-2, B-4, C-1, D-3", "correct": false}], "correct_answer": "A. A-1, B-3, C-2, D-4", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/CAPlRkyd6DzLPLuXcd4V1746431494.png", "https://image.prepladder.com/notes/XeEEsHfRu5cgCD7TTteE1746431542.png", "https://image.prepladder.com/notes/SaM5cWe81A68uyfUpPy01746431583.png", "https://image.prepladder.com/notes/UB2qFM8Cl9wBSyqyIHnP1746431628.png", "https://image.prepladder.com/notes/UequjRkdmcXzrBReg66f1746431660.png", "https://image.prepladder.com/notes/3bUWSFhqYGS8OHD8rBb61746431694.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fracture Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Jones fractures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Significant <span class=\"customMeta\" data-dictid=\"9efe7f9e921692777180ed75f4948a\">adduction</span> force to the foot with a lifted heel (e.g., sudden direction change)</li>\n<li>Location of injury: 4th/5th <span class=\"customMeta\" data-dictid=\"b7f1b05b6d1692777192a18bc2396f\">metatarsal</span> articulation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Ortho \" data-author=\"Mdscottis\" data-hash=\"11766\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Jones_fracture#/media/File:Cropped_version_of_Jonesfracture.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/CAPlRkyd6DzLPLuXcd4V1746431494.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>March Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A stress <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> commonly seen in runners, involving the<strong> metatarsals</strong> due to <strong>repetitive overuse</strong>.</li>\n<li>The patient's gradual onset of pain and <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> after increased running</li>\n<li>X-ray shows no obvious fracture, but a faint <span class=\"customMeta\" data-dictid=\"58c03304521692777195a054ce95e4\">periosteal</span> reaction is seen.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"ortho\" data-author=\"Personalo\" data-hash=\"11768\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/March_fracture\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/XeEEsHfRu5cgCD7TTteE1746431542.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bennett fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Oblique <span class=\"customMeta\" data-dictid=\"f953c828ea16927771909cb3a51e36\">intra-articular</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> (2 part) of the<strong> base of the first <span class=\"customMeta\" data-dictid=\"3582e886271692777192ab233546a6\">metacarpal</span> with <span class=\"customMeta\" data-dictid=\"e53b153fb316927771996481a3e88f\">subluxation</span> of the metacarpal.</strong></li>\n<li>It is caused by a <span class=\"customMeta\" data-dictid=\"7ba18aa5e616927771918a45051a40\">longitudinal</span> force applied to the thumb.</li>\n<li><strong>Treatment: </strong>\n<ul>\n<li>Closed reduction and <span class=\"customMeta\" data-dictid=\"b2fb1a3a5416927771953ea4fa15e1\">percutaneous</span> K-wire fixation</li>\n<li>Open reduction and internal fixation</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Ortho\" data-author=\"JAMES HEILMAN\" data-hash=\"11770\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Bennett%27s_fracture#/media/File:BennettFracMark.png\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/SaM5cWe81A68uyfUpPy01746431583.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Ortho\" data-author=\"NA\" data-hash=\"11771\" data-license=\"NA\" data-source=\"https://sportshanddoctor.com/malunited-bennetts-fracture/\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/UB2qFM8Cl9wBSyqyIHnP1746431628.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Boxer's fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fracture through the <strong>neck of the <span class=\"customMeta\" data-dictid=\"3582e886271692777192ab233546a6\">metacarpal</span> (commonly the 5th metacarpal). </strong></li>\n<li>Cause: Closed fist hits against a hard object</li>\n<li>Treatment: Mostly conservative</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"ortho\" data-author=\"JAMES HEILMAN\" data-hash=\"11772\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Boxer%27s_fracture#/media/File:Fractured5thMetacarpalHead2018.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/UequjRkdmcXzrBReg66f1746431660.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"ortho\" data-author=\"NA\" data-hash=\"11774\" data-license=\"NA\" data-source=\"https://mdwestone.com/boxers-fracture/\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/3bUWSFhqYGS8OHD8rBb61746431694.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An old lady slipped and fell at home. She was diagnosed with a Colles fracture and managed with a POP cast. What is the correct sequence of reduction of the given fracture?", "options": [{"label": "A", "text": "Traction, POP, palmar flexion, ulnar deviation", "correct": false}, {"label": "B", "text": "Traction, palmar flexion, ulnar deviation, POP", "correct": true}, {"label": "C", "text": "Traction, ulnar deviation, palmar flexion, POP", "correct": false}, {"label": "D", "text": "Palmar flexion, ulnar deviation, traction, POP", "correct": false}], "correct_answer": "B. Traction, palmar flexion, ulnar deviation, POP", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/fGy7hiLYJeUCyfwiN98B1745558523.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient with a history of fall few months back presents with the deformity shown in the image. Probing into history reveals it was managed with traditional treatment. This deformity is likely to be due to?", "options": [{"label": "A", "text": "Intra-articular fracture of wrist", "correct": false}, {"label": "B", "text": "Extra-articular fracture of wrist", "correct": true}, {"label": "C", "text": "Barton's fracture", "correct": false}, {"label": "D", "text": "Boxer’s fracture", "correct": false}], "correct_answer": "B. Extra-articular fracture of wrist", "question_images": ["https://image.prepladder.com/notes/VWPrBkiiHcCiZ830M9Pf1746601362.png"], "explanation_images": ["https://image.prepladder.com/notes/VWPrBkiiHcCiZ830M9Pf1746601362.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Fishtail deformity is seen in fracture of", "options": [{"label": "A", "text": "Distal end of radius", "correct": false}, {"label": "B", "text": "Distal end of humerus", "correct": true}, {"label": "C", "text": "Distal end of tibia", "correct": false}, {"label": "D", "text": "Distal end of femur", "correct": false}], "correct_answer": "B. Distal end of humerus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/G3eiYM8tA91g2CuCxasK1745583333.png", "https://image.prepladder.com/content/enXFBkuyDbYcx0nOuzo41745583333.png", "https://image.prepladder.com/content/2AtBTBhGtLmLk4TKXh7A1745583333.png", "https://image.prepladder.com/content/iM3FJRSaBxmuJ3HCWqLb1745583333.png", "https://image.prepladder.com/content/WM1u5NpgCHgjUCtLeBmT1745583333.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:638px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Supracondylar Fractures </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fall on outstretched hand (FOOSH)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Humerus fractures just above the condyles.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Displacements</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> fragment of the <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> is usually displaced by</p>\n<ul>\n<li>Posterior shift (Due to Impaction)</li>\n<li>Posterior Tilt</li>\n<li>Proximal shift</li>\n<li>Medial shift/ Tilt</li>\n<li>Internal rotation</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"242\" src=\"https://image.prepladder.com/content/G3eiYM8tA91g2CuCxasK1745583333.png\" width=\"242\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Type 1:</strong> Undisplaced fracture</li>\n<li><strong>Type 2:</strong> Partially displaced <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> with <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of only <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> cortex</li>\n<li><strong>Type 3:</strong> Completely displaced <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> cortex.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe elbow pain, swelling, deformity, and loss of function may occur, and neurological symptoms like weakness in wrist <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> or the <strong>hand of benediction</strong> sign may also occur if the<strong> <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> nerve</strong> is affected.</li>\n<li>Unusual <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"ebc4d593fd1692777196b50a4faad4\">prominence</span> of the <span class=\"customMeta\" data-dictid=\"42c351f10a1692777194fbc64fc061\">olecranon</span> in the backward tilt <strong>(S-shaped deformity)</strong></li>\n<li>The skin around the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> has a dimpled appearance <strong>(Dimple sign)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>X-ray Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Three bony parts relationship is maintained.</li>\n<li><strong>Fat Pad or Sail sign: </strong>A <span class=\"customMeta\" data-dictid=\"4537d6e7e216927772007d067522aa\">translucent</span> shadow-like appearance representing <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> fat pads.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Hellerhoff \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Fat_pad_sign#/media/File:Fettpolsterzeichen_pathologisch_Ellenbogen.png\" data-tags=\"\" height=\"274\" src=\"https://image.prepladder.com/content/enXFBkuyDbYcx0nOuzo41745583333.png\" width=\"265\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Disturbed teardrop sign:</strong> An <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> appearance of the fat pad, suggesting the presence of an injury, such as a <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> or joint effusion.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mous A, Hacking C, Campos A\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/supracondylar-humeral-fracture-2\" data-tags=\"\" height=\"276\" src=\"https://image.prepladder.com/content/2AtBTBhGtLmLk4TKXh7A1745583333.png\" width=\"291\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<ul>\n<li><strong>Fishtail sign: </strong>The ends of the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> fragment are slightly widened and serrated, resembling a fishtail<strong>.</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Supracondylar_humerus_fracture#/media/File:Supracondylar09.JPG\" data-tags=\"\" height=\"262\" src=\"https://image.prepladder.com/content/iM3FJRSaBxmuJ3HCWqLb1745583333.png\" width=\"227\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Crescent sign: </strong>The normal <span class=\"customMeta\" data-dictid=\"17825c11c616927771979bd9b0b285\">radiolucent</span> gap of the <span class=\"customMeta\" data-dictid=\"3fead70a341692777187431ed9d5e0\">elbow joint</span> is replaced by a crescent-shaped shadow from the <span class=\"customMeta\" data-dictid=\"2f2b8ee27316927771830e8372cc12\">capitulum</span> overlapping the olecranon, indicating <span class=\"customMeta\" data-dictid=\"5cdf29eaf516927772012b4a16cde1\">varus</span> or <span class=\"customMeta\" data-dictid=\"e33d939e82169277720167f59b0ee2\">valgus</span> tilt of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> fragment.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Shakoor A Baig M N Baig\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/figure/X-ray-hip-Crescent-sign-Arrows-showing-the-hypointense-crescent_fig1_327142356\" data-tags=\"\" height=\"229\" src=\"https://image.prepladder.com/content/WM1u5NpgCHgjUCtLeBmT1745583333.png\" width=\"226\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Based on the type of fracture</p>\n<ul>\n<li><strong>Undisplaced fracture: </strong>Immobilisation in above-elbow <span class=\"customMeta\" data-dictid=\"6c22f2390016927771955c0c04b851\">plaster</span> slab with the elbow in 90-degree flexion.</li>\n<li><strong>Displaced fractures</strong>\n<ul>\n<li>Closed reduction with <span class=\"customMeta\" data-dictid=\"b2fb1a3a5416927771953ea4fa15e1\">percutaneous</span> K-wire fixation. (for Type 2 fracture)</li>\n<li>Open reduction internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> with K-wire. (for Type 3 fracture)</li>\n</ul>\n</li>\n<li><strong>In Late presentation with swelling</strong>\n<ul>\n<li>Dunlop <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> (skin)</li>\n<li>Smith <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> (skeletal)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Early complications</strong>\n<ul>\n<li>Vascular injury (commonly Brachial artery)</li>\n<li>Nerve injury (commonly <strong>Anterior Interosseous nerve</strong>)</li>\n</ul>\n</li>\n<li><strong>Delayed complications</strong>\n<ul>\n<li><strong>Cubitus <span class=\"customMeta\" data-dictid=\"5cdf29eaf516927772012b4a16cde1\">varus</span> or Gunstock <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> (Malunion)</strong></li>\n<li>Volkmann's Ischemia and <span class=\"customMeta\" data-dictid=\"ce3edddb5116927771844c030f3c1e\">compartment</span> syndrome.</li>\n<li>Elbow stiffness</li>\n<li>Myositis ossificans.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most specific test used to diagnose carpal tunnel syndrome?", "options": [{"label": "A", "text": "Durkan's test", "correct": true}, {"label": "B", "text": "Phalen test", "correct": false}, {"label": "C", "text": "Tinel test", "correct": false}, {"label": "D", "text": "Two point discrimination", "correct": false}], "correct_answer": "A. Durkan's test", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<thead>\n<tr>\n<th colspan=\"2\" scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Carpal tunnel syndrome</strong></p>\n</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Compression of the <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> nerve as it passes through the <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> tunnel in the wrist</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Numbness, <span class=\"customMeta\" data-dictid=\"b7020a23961692777200b1237ae429\">tingling</span> in thumb, index, and middle fingers</li>\n<li>Pain in hand and wrist</li>\n<li>Weakness in grip</li>\n<li>Symptoms often <strong>worse at night </strong>and improve during the day.</li>\n<li>Advanced cases may lead to constant symptoms, hand weakness, clumsiness, and muscle atrophy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structures Affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Median Nerve</strong>: Compressed within the <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> tunnel, leading to symptoms and signs.</li>\n<li><strong>Flexor Tendons</strong>: The nine <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> tendons passing through the <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> tunnel can become inflamed, further compressing the <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> nerve.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structures Spared</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Thenar Eminence</strong>: <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">Sensory</span> loss generally spares this area because its nerve (palmar <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> nerve) bypasses the <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> tunnel.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Weakness: </strong>Notable weakness in thumb <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> and opposition.</li>\n<li><strong>Atrophy</strong>: Possible <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> of the <span class=\"customMeta\" data-dictid=\"48c587f4c51692777200fe869f1699\">thenar</span> <span class=\"customMeta\" data-dictid=\"c7cd7c82631692777187abb016ed2e\">eminence</span> in advanced cases.</li>\n<li><strong>Sensory Loss</strong>: Loss typically affects the <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> nerve distribution (thumb, index, middle, and <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> half of the fourth digit).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Idiopathic-</strong> commonest cause</li>\n<li><strong>Inflammatory causes- </strong>Rheumatoid arthritis, wrist osteoarthritis</li>\n<li><strong>Post-traumatic causes-</strong> Bone thickening after a Colles' fracture</li>\n<li><strong>Endocrine causes-</strong> Myxoedema, Acromegaly</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nerve <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">Conduction</span> Studies (NCS) - primary <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test</li>\n<li>Electromyography (EMG)</li>\n<li><strong>Carpal <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">Compression</span> Test/ Durkan test</strong>: <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">Diagnostic</span> test. Positive if pain/paresthesias occur during pressure application over the <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> tunnel.</li>\n<li><strong>Phalen Test</strong>: Positive if pain/paresthesias arise during wrist flexion. <strong>(Option B ruled out)</strong></li>\n<li><strong>Tinel Test:</strong> Positive if tapping over the <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> tunnel elicits symptoms. <strong>(Option C ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Conservative: Wrist splinting, NSAIDs, activity modification</li>\n<li>Corticosteroid injections</li>\n<li>Surgical: <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">Carpal</span> tunnel release (for severe or <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> cases)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the following fracture:", "options": [{"label": "A", "text": "Colles Fracture", "correct": false}, {"label": "B", "text": "Monteggia Fracture", "correct": true}, {"label": "C", "text": "Barton's Fracture", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "B. Monteggia Fracture", "question_images": ["https://image.prepladder.com/content/GztlMknw4eg9LvKmQTee1746706527.png"], "explanation_images": ["https://image.prepladder.com/content/Eo1Tf5O9lTnVTcVv6KVg1746706560.png", "https://image.prepladder.com/content/tQCpqjSQkuagYRkK4xsl1746706560.png", "https://image.prepladder.com/content/ciBVlp8sAAz4ZSbCp5jm1746706560.png", "https://image.prepladder.com/content/ZWvlOXC1frAsKco6Bwyc1746706560.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:622px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Monteggia fracture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Site </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fracture of the <strong>proximal third of the ulna</strong> is accompanied by a <strong>radial head dislocation</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fall on an outstretched hand</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"402\" src=\"https://image.prepladder.com/content/Eo1Tf5O9lTnVTcVv6KVg1746706560.png\" width=\"711\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Nerve injury (Posterior Interosseous Nerve)</strong></li>\n<li>Malunion</li>\n<li>Non-union</li>\n<li>Cubitus valgus.</li>\n<li>Radio <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> <span class=\"customMeta\" data-dictid=\"6aec71db0e169277719908863ce421\">synostosis</span> (Type 4 Monteggia Fracture)</li>\n<li>Myositis Ossificans.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23 year old male epileptic patient presented with pain in right shoulder region. Examination revealed that right upper limb was abducted and externally rotated and the movements could not be performed. Which of the following is most likely diagnosed", "options": [{"label": "A", "text": "Intrathoracic dislocation of shoulder", "correct": false}, {"label": "B", "text": "Luxation erecta", "correct": false}, {"label": "C", "text": "Subglenoid dislocation of shoulder", "correct": true}, {"label": "D", "text": "Posterior dislocation of shoulder", "correct": false}], "correct_answer": "C. Subglenoid dislocation of shoulder", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/7wuleQW1cI23q8AoCGN51741061599.png", "https://image.prepladder.com/content/dKhnOSi1yaaYe2yRYrlJ1741061627.png", "https://image.prepladder.com/content/GDsfaMPluB1b8oprVNYC1741061642.png", "https://image.prepladder.com/content/QENfYtfbCfpBoGn519mn1741061669.png", "https://image.prepladder.com/content/Vt43htE4UrDtgcHN6FpD1741061695.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:663px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior dislocation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior dislocation</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inferior dislocation</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Frequency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Most common</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not very common</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fall on an outstretched hand with an abducted and externally rotated shoulder.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs during <strong>seizures or convulsions</strong>.</p>\n<ul>\n<li>A fall onto a <strong>flexed, adducted arm</strong>.</li>\n<li>A direct impact to the <strong>anterior aspect of the shoulder</strong>.</li>\n<li>A fall onto an <strong>outstretched hand</strong>.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Also called <strong>luxatio erecta.</strong></li>\n<li>Result from a severe hyper-abduction force.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical presentation</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pain, <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> and movement restriction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Duga’s test, Hamilton ruler test and Regimental <span class=\"customMeta\" data-dictid=\"3fb38cd2a416927771822103bd8bcd\">badge</span> test.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Callaway’s test and Regimental <span class=\"customMeta\" data-dictid=\"3fb38cd2a416927771822103bd8bcd\">badge</span> test</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bryant’s test</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arm Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Abduction and external rotation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adduction and internal rotation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arm locked in hyperabduction with the hand positioned above the head.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The humeral head is displaced anteriorly and inferiorly, often under the <span class=\"customMeta\" data-dictid=\"6d706ad0a916927771852098e31258\">coracoid</span> process <strong>(\"subcoracoid\" position).</strong></li>\n<li><strong>\"Hill-Sachs lesion\" </strong>(compression <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> on the <span class=\"customMeta\" data-dictid=\"0b858004a11692777196bac353c12b\">posterolateral</span> aspect of the humeral head).</li>\n<li><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"242\" src=\"https://image.prepladder.com/content/7wuleQW1cI23q8AoCGN51741061599.png\" width=\"187\"/></li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The humeral head is displaced posteriorly, appearing closer to the scapula.</li>\n<li><strong>‘Light bulb sign</strong>’(humeral head appears rounded due to internal rotation).</li>\n<li><strong>‘Rim sign’</strong> (widening of the <span class=\"customMeta\" data-dictid=\"138e482a341692777188df645a942c\">glenohumeral</span> joint space).</li>\n<li><strong>‘Reverse Hill-Sachs lesion’</strong> (compression <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> on the <span class=\"customMeta\" data-dictid=\"f90b38d04f16927771818db430bf86\">anteromedial</span> humeral head).</li>\n<li><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"167\" src=\"https://image.prepladder.com/content/dKhnOSi1yaaYe2yRYrlJ1741061627.png\" width=\"192\"/></li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The humeral head is displaced inferiorly below the <span class=\"customMeta\" data-dictid=\"7649bd0f191692777188dcdf91af69\">glenoid</span> cavity.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"252\" src=\"https://image.prepladder.com/content/GDsfaMPluB1b8oprVNYC1741061642.png\" width=\"187\"/></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduction techniques:</p>\n<ul>\n<li><strong>Kocher's method </strong>(Most commonly used)</li>\n<li>Hippocrates method</li>\n<li>Stimson’s technique</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduction and immobility, followed by active exercises.</p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Closed reduction</li>\n<li>Open reduction if soft tissue injuries are present</li>\n<li>Re-examination after reduction to avoid <span class=\"customMeta\" data-dictid=\"d100eb4ed81692777193b7f47b5cba\">neurovascular</span> injuries.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Early:</strong>\n<ul>\n<li>Neurovascular injuries</li>\n<li>Rotator <span class=\"customMeta\" data-dictid=\"074fda92471692777185c9d613a2ea\">cuff</span> tear</li>\n</ul>\n</li>\n<li><strong>Delayed:</strong>\n<ul>\n<li>Recurrence</li>\n<li>Stiffness</li>\n<li>Unreduced dislocation</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recurrence</li>\n<li>Unreduced dislocation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Neurovascular injuries</li>\n<li>Recurrence</li>\n<li>Unreduced dislocation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:643px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior Shoulder <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subtypes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Subglenoid</strong>: The humeral head lies below the <span class=\"customMeta\" data-dictid=\"7649bd0f191692777188dcdf91af69\">glenoid</span> fossa.</li>\n<li><strong>Subclavicular</strong>: The humeral head is displaced beneath the clavicle.</li>\n<li><strong>Intrathoracic</strong>: The humeral head dislocates into the <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> cavity, which is rare.</li>\n<li><strong>Subcoracoid</strong>: The humeral head lies below the <span class=\"customMeta\" data-dictid=\"6d706ad0a916927771852098e31258\">coracoid</span> process.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"595\" src=\"https://image.prepladder.com/content/QENfYtfbCfpBoGn519mn1741061669.png\" width=\"593\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Loss of the <span class=\"customMeta\" data-dictid=\"70d60276a81692777185b5f6f71fa9\">deltoid</span> <span class=\"customMeta\" data-dictid=\"21f826cc7316927771858a31dad57d\">contour</span> (loss of shoulder roundness)</li>\n<li>The shoulder is <strong>extended, abducted and externally rotated</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Duga’s test</strong> is the inability to touch the opposite shoulder.</li>\n<li><strong>Hamilton ruler</strong> test is where the gap between the ruler and the arm is lost.</li>\n<li><strong>Callaway’s test</strong> is increased girth of the <span class=\"customMeta\" data-dictid=\"a6218759db1692777182316d0cd2aa\">axilla</span> on the dislocated side.</li>\n<li><strong>Bryant’s Test</strong> is where the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> axillary fold is displaced downward on the affected side.</li>\n<li><strong>Regiment batch sign</strong> is loss of sensation due to axillary nerve damage.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>X-ray reveals that the humeral head is displaced anteriorly and inferiorly, often under the <span class=\"customMeta\" data-dictid=\"6d706ad0a916927771852098e31258\">coracoid</span> process <strong>(\"subcoracoid\" position)</strong></li>\n<li>An MRI is necessary to assess soft-tissue injuries and identify Bankart and Hill-Sachs lesions, which are complications of shoulder dislocations and increase the risk of <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> due to joint instability.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"581\" src=\"https://image.prepladder.com/content/Vt43htE4UrDtgcHN6FpD1741061695.png\" width=\"457\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Management</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Kocher's method </strong>(Most common method) is the reduction by <strong>traction, external rotation, adduction, and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> rotation.</strong></li>\n<li>In <strong>Hippocrates' method, </strong>the surgeon pulls the semi-abducted arm firmly while using his foot in the <span class=\"customMeta\" data-dictid=\"a6218759db1692777182316d0cd2aa\">axilla</span> as a fulcrum to reduce the dislocation.<strong> </strong></li>\n<li><strong>Stimson’s technique</strong> is the reduction by applying weight for traction, using the body as counter traction.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Three point bony relationship has a diagnostic value in:", "options": [{"label": "A", "text": "Monteggia fracture", "correct": true}, {"label": "B", "text": "Elbow fracture", "correct": false}, {"label": "C", "text": "Colles fracture", "correct": false}, {"label": "D", "text": "Galeazzi fracture", "correct": false}], "correct_answer": "A. Monteggia fracture", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cBOdLduKTyutxDrsTA7A1747033505.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25 year old man fell down while running. He tried to sustain the fall on his elbow resulting in the injury shown below.What will be the appropriate management of the following fracture?", "options": [{"label": "A", "text": "Above elbow plaster slab", "correct": false}, {"label": "B", "text": "Below elbow plaster slab", "correct": false}, {"label": "C", "text": "Close reduction with Tension band wiring", "correct": false}, {"label": "D", "text": "Immobilization of elbow, Above elbow plaster slab with 30 degree flexion", "correct": true}], "correct_answer": "D. Immobilization of elbow, Above elbow plaster slab with 30 degree flexion", "question_images": ["https://image.prepladder.com/content/ynInshJd6U435z1cOtCw1748153548.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The diagnosis of the given image", "options": [{"label": "A", "text": "Scapho lunate instability", "correct": true}, {"label": "B", "text": "Lunate injury", "correct": false}, {"label": "C", "text": "Distal radio ulnar joint instability", "correct": false}, {"label": "D", "text": "Wrist dislocation", "correct": false}], "correct_answer": "A. Scapho lunate instability", "question_images": ["https://image.prepladder.com/content/wmuJZw658GpaTI41zxPA1747033741.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Postmenopausal woman slipped and fell down on an outstretched hand in the washroom. X-ray of her distal forearm is given below. Diagnose the following condition?", "options": [{"label": "A", "text": "Colle's Fracture", "correct": true}, {"label": "B", "text": "Monteggia fracture", "correct": false}, {"label": "C", "text": "Smith Fracture", "correct": false}, {"label": "D", "text": "Galeazzi fracture", "correct": false}], "correct_answer": "A. Colle's Fracture", "question_images": ["https://image.prepladder.com/content/qoSt59cu2nMYiOHpMXN81748153842.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Fracture Name</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Characteristic Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Sites Involved</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Special History</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Colles</strong></p>\n<p><strong>Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dorsal <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> radius.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distal radius</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Falling on an outstretched hand</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Smith's</strong></p>\n<p><strong>Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Volar <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> radius.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distal radius</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Falling on a flexed wrist</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Monteggia</strong></p>\n<p><strong>Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Proximal <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> with <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head dislocation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Proximal ulna, <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Direct blow to the <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> or forearm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Galeazzi</strong></p>\n<p><strong>Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distal <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> with <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"6c5e87b03d1692777197e1150ae78a\">radioulnar</span> joint dislocation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distal radius, <span class=\"customMeta\" data-dictid=\"6c5e87b03d1692777197e1150ae78a\">radioulnar</span> joint</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fall on an outstretched hand with an <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> deviation</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the given fracture?", "options": [{"label": "A", "text": "Colles Fracture", "correct": true}, {"label": "B", "text": "Monteggia Fracture", "correct": false}, {"label": "C", "text": "Galeazzi Fracture", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Colles Fracture", "question_images": ["https://image.prepladder.com/content/htE78AT3uSVNFCygUuIl1700131469.png"], "explanation_images": ["https://image.prepladder.com/content/Uf4tQALoRQWnHSrP7jxo1700131615.png", "https://image.prepladder.com/content/pFBXsR6wKjIRCadcBKQL1700131683.png"], "explanation": "<p>Correct Option A: Colles Fractu\n<table>\n<tbody>\n<tr>\n<td><strong>Definition</strong></td>\n<td>Colles <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> is a type of <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> characterized by a break at the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> end of the <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> bone in the forearm. It often involves <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> and <span class=\"customMeta\" data-dictid=\"1aec9f83db16927771815b94ad8e86\">angulation</span> of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> fragment. Named after the Irish surgeon Abraham Colles.</td>\n</tr>\n<tr>\n<td><strong>Epidemiology</strong></td>\n<td>- Most common type of wrist <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> in adults, particularly in the elderly population. - Often associated with falls onto an outstretched hand.</td>\n</tr>\n<tr>\n<td><strong>Mechanism of Injury</strong></td>\n<td>- Typically occurs due to a fall on an outstretched hand with the wrist extended. - <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">Axial</span> <span class=\"customMeta\" data-dictid=\"00a5dcc74b16927771913b344e36a3\">loading</span> on the <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> leads to the characteristic <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> pattern.</td>\n</tr>\n<tr>\n<td><strong>Clinical Presentation</strong></td>\n<td>- <strong>Deformity:</strong> <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">Dorsal</span> <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> and \"dinner fork\" or \"bayonet\" <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> may be visible. - <strong>Pain:</strong> <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">Localized</span> pain at the site of the fracture. - <strong>Swelling:</strong> Immediate <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> around the wrist.</td>\n</tr>\n<tr>\n<td><strong>Radiographic Features</strong></td>\n<td>- <strong>Dorsal Tilt:</strong> On X-rays, <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> and <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> tilt of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> fragment are characteristic. - <strong>Radial Shortening:</strong> Shortening of the <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> may also be observed.</td>\n</tr>\n<tr>\n<td><strong>Classification</strong></td>\n<td>- <strong>Extra-articular (Type I):</strong> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> occurs just above the wrist joint. - <strong>Partial <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">Articular</span> (Type II):</strong> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> extends into the joint but does not involve the joint surface. - <strong>Complete <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">Articular</span> (Type III):</strong> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> extends into the joint and involves the joint surface.</td>\n</tr>\n<tr>\n<td><strong>Treatment</strong></td>\n<td>- <strong>Closed Reduction and Casting:</strong> Common initial approach, especially for less displaced fractures. - <strong>Open Reduction and Internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">Fixation</span> (ORIF):</strong> Considered for more complex or displaced fractures, or cases where <span class=\"customMeta\" data-dictid=\"da014870171692777184980beab405\">closed reduction</span> is not successful.</td>\n</tr>\n<tr>\n<td><strong>Complications</strong></td>\n<td>- <strong>Malunion:</strong> Improper <span class=\"customMeta\" data-dictid=\"3c0c325f4216927771819e5d0eb581\">alignment</span> during <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> may lead to deformity. - <strong>Nerve or <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">Vascular</span> Injury:</strong> Rare but possible, especially in more severe fractures.</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is incorrect about perilunate dislocation ?", "options": [{"label": "A", "text": "Lunate is dislocated anteriorly but the rest of the carpals remains in position", "correct": true}, {"label": "B", "text": "Lunate remains in position but rest other dislocate dorsally", "correct": false}, {"label": "C", "text": "Involves median nerve injury", "correct": false}, {"label": "D", "text": "Tavernier's manoeuvre is used for closed reduction", "correct": false}], "correct_answer": "A. Lunate is dislocated anteriorly but the rest of the carpals remains in position", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"2c800b393f1692777191e260e94f78\"&gt;Lunate&lt;/span&gt; is dislocated anteriorly but the rest of th\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the following device.", "options": [{"label": "A", "text": "Cock-up splint", "correct": true}, {"label": "B", "text": "Colles' cast", "correct": false}, {"label": "C", "text": "Knuckle bender splint", "correct": false}, {"label": "D", "text": "Dynamic finger splint", "correct": false}], "correct_answer": "A. Cock-up splint", "question_images": ["https://image.prepladder.com/content/Zyhlw1sRswnoPJ9JbEBV1691497132.PNG"], "explanation_images": [], "explanation": "<p>Correct Option A - Cock-u\n<table>\n<tbody>\n<tr>\n<td>\n<p>Cock-up splint</p>\n</td>\n<td>\n<p>Immobilizes and supports the wrist in a neutral or slightly extended position. Used for conditions such as <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> tunnel syndrome and wrist sprains.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Colle’s' cast</p>\n</td>\n<td>\n<p>Circumferential cast used for the treatment of <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> fractures. Immobilizes the wrist and forearm.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Knuckle bender splint</p>\n</td>\n<td>\n<p>Finger <span class=\"customMeta\" data-dictid=\"7f606f911b1692777199eb69ab67c5\">splint</span> used to provide extension support to the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> (PIP) joint of the finger.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Dynamic finger splint</p>\n</td>\n<td>\n<p>Allows controlled movement of the finger joints while providing support and protection. Used in finger injury rehabilitation and post-surgery.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The X-ray image of a patient presented to the casualty is given below. How will you manage this case?", "options": [{"label": "A", "text": "Nailing", "correct": false}, {"label": "B", "text": "Plating", "correct": false}, {"label": "C", "text": "Tension band wiring", "correct": true}, {"label": "D", "text": "Knee splint", "correct": false}], "correct_answer": "C. Tension band wiring", "question_images": ["https://image.prepladder.com/content/u0RjpKkcIWqCXYarBc5g1713873447.png"], "explanation_images": [], "explanation": "<table>\n<thead>\n<tr>\n<th>Aspect</th>\n<th>Details</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Anatomy</td>\n<td>Olecranon is part of the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> and serves as the <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> for the triceps</td>\n</tr>\n<tr>\n<td>Mechanism of Injury</td>\n<td>Direct trauma or fall on outstretched hand with elbow flexed</td>\n</tr>\n<tr>\n<td>Clinical Features</td>\n<td>Pain, swelling, inability to extend the elbow</td>\n</tr>\n<tr>\n<td>X-ray Findings</td>\n<td>Fracture line at the olecranon, often <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> or comminuted</td>\n</tr>\n<tr>\n<td>Non-operative Treatment</td>\n<td>Immobilization in nondisplaced fractures (rare)</td>\n</tr>\n<tr>\n<td>Operative Treatment</td>\n<td>Depends on <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> type:</td>\n</tr>\n<tr>\n<td> </td>\n<td><strong>Tension band wiring</strong> for transverse/simple fractures</td>\n</tr>\n<tr>\n<td> </td>\n<td><strong>Plating</strong> for <span class=\"customMeta\" data-dictid=\"9c8512bb5d169277718470669bd36e\">comminuted</span> or unstable fractures</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the fracture shown in the image?", "options": [{"label": "A", "text": "Radial head fracture", "correct": true}, {"label": "B", "text": "Elbow fracture", "correct": false}, {"label": "C", "text": "Medial epicondyle fracture", "correct": false}, {"label": "D", "text": "Lateral epicondyle fracture", "correct": false}], "correct_answer": "A. Radial head fracture", "question_images": ["https://image.prepladder.com/content/1tcsf297DlM2LGTraAT81747375920.png"], "explanation_images": ["https://image.prepladder.com/content/GWAK45DR9i3o9apjeKAw1747375930.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:617px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of the <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head, the upper part of the <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> that articulates with the <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> and <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> at the elbow joint.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Causes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Most commonly caused by a fall onto an outstretched hand (FOOSH)</li>\n<li>Direct trauma or a blow to the elbow</li>\n<li>MVA (Motor Vehicle Accidents) or sports injuries</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Types of Fractures</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Type I: Non-displaced <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> (usually treated conservatively)</li>\n<li>Type II: Displaced <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> with a single fragment (may require <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention)</li>\n<li>Type III: <span class=\"customMeta\" data-dictid=\"9c8512bb5d169277718470669bd36e\">Comminuted</span> (multiple fragments, often requiring <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> or replacement)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pain and <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> at the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> aspect of the elbow</li>\n<li>Swelling and bruising around the elbow joint</li>\n<li>Limited range of motion, with <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> and extension</li>\n<li>Difficulty <span class=\"customMeta\" data-dictid=\"d3daf86e63169277719936e262ff26\">supination</span> and pronation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tenderness, swelling, and limited motion.</li>\n<li>X-rays: Used to classify the type and <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of the fracture.</li>\n<li>CT scan: Used for more complex fractures.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treatment Options</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Conservative management: For non-displaced (Type I) fractures.</li>\n<li>Surgical management: For displaced (Type II) or <span class=\"customMeta\" data-dictid=\"9c8512bb5d169277718470669bd36e\">comminuted</span> (Type III) fractures- <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head fixation, replacement (arthroplasty), or excision.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Complications</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Loss of elbow range of motion</li>\n<li>Chronic pain</li>\n<li>Elbow instability</li>\n<li>Post-traumatic arthritis</li>\n<li>Stiffness or <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> of the joint</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following fractures can cause a deformity as shown in the image below?", "options": [{"label": "A", "text": "Lateral condyle of humerus fracture", "correct": false}, {"label": "B", "text": "Monteggia fracture", "correct": false}, {"label": "C", "text": "Supracondylar fracture of humerus", "correct": true}, {"label": "D", "text": "Shaft of humerus fracture", "correct": false}], "correct_answer": "C. Supracondylar fracture of humerus", "question_images": ["https://image.prepladder.com/content/TZW6B3O2yMsGqgdDFe5P1724909221.png"], "explanation_images": ["https://image.prepladder.com/content/NBQFzTnp9Zp9BSnnMf1w1724838850.png"], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"043a86fa0016927771998a67e65e6a\"&gt;Supracondylar&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\"&gt;fracture&lt;/span&gt; of humeru\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Linear growth of bone is disturbed when a fracture occurs in which of the following locations?", "options": [{"label": "A", "text": "Epiphysis", "correct": false}, {"label": "B", "text": "Diaphysis", "correct": false}, {"label": "C", "text": "Metaphysis", "correct": false}, {"label": "D", "text": "Epiphyseal plate", "correct": true}], "correct_answer": "D. Epiphyseal plate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"dc486020a916927771874098596bbc\"&gt;Epiphyseal&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which classification is used for the following fracture, and what is its stage?", "options": [{"label": "A", "text": "Gartland 3", "correct": true}, {"label": "B", "text": "Gartland 2", "correct": false}, {"label": "C", "text": "Salter harris 3", "correct": false}, {"label": "D", "text": "Salter harris 2", "correct": false}], "correct_answer": "A. Gartland 3", "question_images": ["https://image.prepladder.com/content/9j4dZSPEZIHLwgcnqdb81724755617.png"], "explanation_images": ["https://image.prepladder.com/content/tVf6CF0McVo3DEJX7jgD1724837186.png", "https://image.prepladder.com/content/UU7UgJVDoAKRHp93IQOE1724837214.png"], "explanation": "<p>Correct Option A - Gartland 3\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the fracture:", "options": [{"label": "A", "text": "Depressed fracture", "correct": true}, {"label": "B", "text": "Linear fracture", "correct": false}, {"label": "C", "text": "Hinge fracture", "correct": false}, {"label": "D", "text": "Gutter fracture", "correct": false}], "correct_answer": "A. Depressed fracture", "question_images": ["https://image.prepladder.com/content/HjvaXUB3kYek38vYxw4U1741086932.png"], "explanation_images": ["https://image.prepladder.com/content/YiFLBqku6FTOjzax3wJq1741060573.png", "https://image.prepladder.com/content/onK1hGFQSfueiFaddICX1741060592.png", "https://image.prepladder.com/content/Zlr8iFHchhsdA7JXq4FH1741060608.png", "https://image.prepladder.com/content/Ke0VUG38SDJD8QRwV91X1741060664.png", "https://image.prepladder.com/content/itnjgJUSiq39izfu0uhF1741060690.png", "https://image.prepladder.com/content/NurZERQYVxov9C5mZmNY1741060738.png", "https://image.prepladder.com/content/Dy62gEKyrvLmbgNeB8nA1741060990.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Depressed Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Comminuted Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Gutter Fracture</strong></p>\n<p style=\"text-align: center;\"><strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">Occurs when a fragment of the skull is pushed inward towards the brain.</li>\n<li style=\"text-align: center;\">Caused by blows from heavy objects with a small surface (e.g., hammers, bricks).</li>\n<li style=\"text-align: center;\">The shape of the depressed area may resemble the object that caused the injury.</li>\n</ul>\n<p style=\"text-align: center;\"><u>Variants:</u></p>\n<ul>\n<li style=\"text-align: center;\"><u>Elevated Fracture</u>: One end of the fractured fragment is raised above the skull, while the other is pushed inward. Caused by sharp objects like an axe.</li>\n<li style=\"text-align: center;\"><u>Pond Fracture</u>: Seen in infants, this smooth depression occurs without a <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> line, resembling <strong>a dent in a ping-pong ball.</strong> Caused by <span class=\"customMeta\" data-dictid=\"9427862c811692777194034ade4877\">obstetrics</span> <span class=\"customMeta\" data-dictid=\"c01b366a9c1692777203ef77069d2c\">forceps</span> blade.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">Involves multiple intersecting <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> lines, breaking the bone into several fragments.</li>\n<li style=\"text-align: center;\">Caused by high-impact trauma (e.g., vehicular accidents, crushing injuries).</li>\n<li style=\"text-align: center;\">It may occur alongside other fractures (e.g., fissured or depressed fractures).</li>\n<li style=\"text-align: center;\">Spider web-like patterns on an <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> are characteristic of <span class=\"customMeta\" data-dictid=\"9c8512bb5d169277718470669bd36e\">comminuted</span> fractures.</li>\n<li style=\"text-align: center;\">In severe cases, bone fragments may penetrate the brain or become displaced.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">A <span class=\"customMeta\" data-dictid=\"21ee3a5f911692777188099a3310c4\">groove</span> or channel is formed in the skull bone, often due to <strong>an <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> bullet wound. </strong></li>\n<li style=\"text-align: center;\">Frequently associated with <span class=\"customMeta\" data-dictid=\"9c8512bb5d169277718470669bd36e\">comminuted</span> and depressed fractures of the inner skull table.</li>\n<li style=\"text-align: center;\">Bone fragments can cause injury to the <span class=\"customMeta\" data-dictid=\"f171f7433d1692777192c344425c41\">meninges</span> or brain.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"186\" src=\"https://image.prepladder.com/content/YiFLBqku6FTOjzax3wJq1741060573.png\" width=\"235\"/></p>\n<p style=\"text-align: center;\"><strong>Depressed fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"282\" src=\"https://image.prepladder.com/content/onK1hGFQSfueiFaddICX1741060592.png\" width=\"142\"/></p>\n<p style=\"text-align: center;\"><strong>Comminuted fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"212\" src=\"https://image.prepladder.com/content/Zlr8iFHchhsdA7JXq4FH1741060608.png\" width=\"212\"/></p>\n<p style=\"text-align: center;\"><strong>Gutter fracture</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Ring Fracture</strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Motorcyclist <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> (Hinge Fracture)</strong></p>\n<p style=\"text-align: center;\"><strong>(Option C)</strong></p>\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">Encircles the <strong>foramen magnum</strong> at the skull base.</li>\n<li style=\"text-align: center;\">Runs from the <span class=\"customMeta\" data-dictid=\"02db2e09e91692777198e14771cb3b\">sella</span> turcica to the <span class=\"customMeta\" data-dictid=\"88225eeb1616927771954c1b0bc1e3\">petrous</span> ridges and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> fossa.</li>\n<li style=\"text-align: center;\">It can extend to the <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> and roof of the nose.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">Transverse <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> at the skull base, <span class=\"customMeta\" data-dictid=\"073b3993a6169277719966873c2515\">splitting</span> it and creating a <strong>\"hinge\" - nodding face sign</strong><strong>.</strong></li>\n<li style=\"text-align: center;\">It extends from one <span class=\"customMeta\" data-dictid=\"88225eeb1616927771954c1b0bc1e3\">petrous</span> ridge across the <span class=\"customMeta\" data-dictid=\"02db2e09e91692777198e14771cb3b\">sella</span> turcica to the other <span class=\"customMeta\" data-dictid=\"88225eeb1616927771954c1b0bc1e3\">petrous</span> ridge.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Caused by:</p>\n<ul>\n<li style=\"text-align: center;\">Falls landing on feet/buttocks (force transmitted through the spine).</li>\n<li style=\"text-align: center;\">Heavy blows to the top of the skull/ vertex.</li>\n<li style=\"text-align: center;\">Twisting of the head on the spine.</li>\n<li style=\"text-align: center;\">Blows to the <span class=\"customMeta\" data-dictid=\"d4214cf5bc1692777194bd76243b92\">occiput</span> or chin.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Often caused by <strong>side impacts</strong>.</p>\n<p style=\"text-align: center;\"><br/>\n\t\t\t </p>\n<p style=\"text-align: center;\"> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"261\" src=\"https://image.prepladder.com/content/Ke0VUG38SDJD8QRwV91X1741060664.png\" width=\"225\"/></p>\n<p style=\"text-align: center;\"><strong>Ring fracture</strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"341\" src=\"https://image.prepladder.com/content/itnjgJUSiq39izfu0uhF1741060690.png\" width=\"337\"/></p>\n<p style=\"text-align: center;\"><strong>Hinge fracture</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fissured <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> (Linear Fracture)</strong></p>\n<p style=\"text-align: center;\"><strong>(Option B)</strong></p>\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diastatic <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> (Sutural Fracture) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">The most common skull <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> accounts for about 70% of cases.</li>\n<li style=\"text-align: center;\">Linear cracks may involve the <span class=\"customMeta\" data-dictid=\"47effe8b551692777201331142edf5\">vertex</span> or skull base. It can affect the full <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> of the bone or just the inner/outer layers.</li>\n<li style=\"text-align: center;\">The <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> line is <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> and fine, sometimes hard to detect on X-rays. It runs <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to the compressive force.</li>\n<li style=\"text-align: center;\">No depression of bone fragments.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">Involves the separation of <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> sutures.</li>\n<li style=\"text-align: center;\">More common in children.</li>\n<li style=\"text-align: center;\">Often occurs with other skull fractures, especially fissured fractures.</li>\n<li style=\"text-align: center;\">Commonly seen at the <span class=\"customMeta\" data-dictid=\"862a709fba1692777198c35e274398\">sagittal</span> suture.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><u>Causes:</u></p>\n<ul>\n<li style=\"text-align: center;\">Impact against broad surfaces (e.g., falls or road traffic accidents)</li>\n<li style=\"text-align: center;\">Falls on <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> or buttocks, transmitting force upwards.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><u>Causes:</u></p>\n<ul>\n<li style=\"text-align: center;\">Blunt trauma to the head.</li>\n<li style=\"text-align: center;\"><strong>Increased <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure leads to <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> separation.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"156\" src=\"https://image.prepladder.com/content/NurZERQYVxov9C5mZmNY1741060738.png\" width=\"367\"/></p>\n<p style=\"text-align: center;\"><strong>Narrow <span class=\"customMeta\" data-dictid=\"b2af124a931692777203c9f8031b77\">fissure</span> skull fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"342\" src=\"https://image.prepladder.com/content/Dy62gEKyrvLmbgNeB8nA1741060990.png\" width=\"328\"/></p>\n<p style=\"text-align: center;\"><strong>Diastatic Fracture</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 17-year-old boy who fell on an outstretched hand is now experiencing pain and swelling at the base of the thumb. Which bone is most likely fractured?", "options": [{"label": "A", "text": "Lunate", "correct": false}, {"label": "B", "text": "Scaphoid", "correct": true}, {"label": "C", "text": "Pisiform", "correct": false}, {"label": "D", "text": "Trapezoid", "correct": false}], "correct_answer": "B. Scaphoid", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/iG2H8KTFgmW1Ose4gghR1747288351.png", "https://image.prepladder.com/notes/noA9BZfAbcZr1tCwyFPu1747826473.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:666px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Scaphoid fracture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Site </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Waist of <span class=\"customMeta\" data-dictid=\"4992469b3c169277719874a6808793\">scaphoid</span> (most common) </strong></li>\n<li>Distal pole (Least common)</li>\n<li>Proximal pole (high risk for <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> necrosis)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Typically caused by a <strong>fall on an outstretched hand (FOOSH)</strong> with the wrist in dorsiflexion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>It is more common in young adults</strong>, particularly athletes.</li>\n<li>Pain and <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> localised to the <strong>anatomical snuffbox</strong> (the depression between the tendons of the <span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\">extensor</span> pollicis <span class=\"customMeta\" data-dictid=\"7ff574b4f61692777191fa536b5e6c\">longus</span> and the <span class=\"customMeta\" data-dictid=\"1a19c0413216927771801f371db10e\">abductor</span> pollicis longus/extensor pollicis brevis).</li>\n<li>Swelling and <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"069cba94231692777197b41e753795\">range of motion</span> at the wrist.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>X-ray </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>There is a visible <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> line at the waist of the scaphoid, with possible <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> or displacement; <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> may later appear as <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> in the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> pole.</p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Gilo1969\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://en.wikipedia.org/wiki/Scaphoid_fracture\" data-tags=\"\" height=\"265\" src=\"https://image.prepladder.com/content/iG2H8KTFgmW1Ose4gghR1747288351.png\" width=\"189\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immobilisation by <span class=\"customMeta\" data-dictid=\"4992469b3c169277719874a6808793\">scaphoid</span> cast (3-4 months)</p>\n<p><img alt=\"OR284-Management of Scaphoid Fracture\" data-author=\"\" data-hash=\"13084\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" height=\"480\" src=\"https://image.prepladder.com/notes/noA9BZfAbcZr1tCwyFPu1747826473.png\" width=\"550\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Avascular <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> (more common in the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> pole)</li>\n<li>Humpback <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> (displaced <span class=\"customMeta\" data-dictid=\"4992469b3c169277719874a6808793\">Scaphoid</span> fracture)</li>\n<li>Delayed and non-union</li>\n<li>Wrist osteoarthritis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the fracture?", "options": [{"label": "A", "text": "Lateral epicondyle fracture", "correct": true}, {"label": "B", "text": "Medial epicondyle fracture", "correct": false}, {"label": "C", "text": "Supra condyle fracture", "correct": false}, {"label": "D", "text": "Infra condyle fracture", "correct": false}], "correct_answer": "A. Lateral epicondyle fracture", "question_images": ["https://image.prepladder.com/content/Covzo8P3OSR1ISXX0LIj1747376016.png", "https://image.prepladder.com/content/Yi4X7aVjEmPhQm3R8PwQ1747376026.png"], "explanation_images": ["https://image.prepladder.com/content/uxWAe3o2m3KKSVrbhxR71747376041.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:618px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> involving the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"ca4c4e935616927771849e13b0396f\">condyle</span> of the humerus. It is typically seen in children.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Causes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Most commonly by direct trauma to the elbow (Fall on the outstretched hand or a direct blow).</li>\n<li>Torsional forces during activity or sports.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Types of Fractures</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Type I: Non-displaced fractures (usually treated conservatively).</li>\n<li>Type II: Displaced fractures (may require <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention).</li>\n<li>Type III: Comminuted fractures with significant <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> (often require surgery).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pain and <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> around the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> aspect of the elbow.</li>\n<li>Limited range of motion, especially during extension and rotation.</li>\n<li>Deformity or <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> positioning of the <span class=\"customMeta\" data-dictid=\"3fead70a341692777187431ed9d5e0\">elbow joint</span> (in more severe cases).</li>\n<li>Tenderness over the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> condyle.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clinical examination: History of trauma, swelling, and deformity.</li>\n<li>X-rays: To assess <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> type and displacement. <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> and <span class=\"customMeta\" data-dictid=\"603878db1116927771812fecb63aec\">AP</span> views are commonly taken.</li>\n<li>CT scan: Can help evaluate complex fractures or assess joint involvement.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treatment Options</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Non-displaced fractures (Type I): Conservative management with rest, ice, and a <span class=\"customMeta\" data-dictid=\"5e2a7b127c1692777198f4895cc7c0\">sling</span> or cast for immobilization.</li>\n<li>Displaced fractures (Type II): Require <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> fixation, such as the use of pins or screws.</li>\n<li>Comminuted fractures (Type III): Open reduction and internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> (ORIF).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Complications</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Elbow <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> or loss of range of motion.</li>\n<li>Malunion or improper healing, leading to <span class=\"customMeta\" data-dictid=\"777420204116927771812106969c5e\">angular</span> deformity.</li>\n<li>Post-traumatic <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> due to joint surface involvement.</li>\n<li>Nerve injury (Radial nerve) due to <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> or <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7 year old boy is brought to the OPD. He fell on his outstretched arm while riding on his cycle. Clinical examination findings are presented in the image below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Dorsal displacement supracondylar fracture of humerus", "correct": false}, {"label": "B", "text": "Undisplaced supracondylar fracture", "correct": false}, {"label": "C", "text": "Malunion of a supracondylar fracture of humerus", "correct": true}, {"label": "D", "text": "Proximal humerus fracture", "correct": false}], "correct_answer": "C. Malunion of a supracondylar fracture of humerus", "question_images": ["https://image.prepladder.com/content/U9E3j7vR1z7LbEWnP0Lw1747376357.png"], "explanation_images": ["https://image.prepladder.com/content/nXS78u9gtcN9XWxtcjBI1747376371.png", "https://image.prepladder.com/content/RUQz6N83bEtkSfiWI1ne1747376378.png", "https://image.prepladder.com/content/PA4i6ct6OhKCPDW9xxyE1747376391.png", "https://image.prepladder.com/content/lyCFGmXDoKkuJOvzYPZC1747376406.png", "https://image.prepladder.com/content/SobJbK3Y6EYz0JdaAHx81747376428.png", "https://image.prepladder.com/content/9GoVUbWIVhFEbR53rbqd1747376443.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:638px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Supracondylar Fractures </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fall on outstretched hand (FOOSH)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Humerus fractures just above the condyles.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Displacements</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> fragment of the <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> is usually displaced by</p>\n<ul>\n<li>Posterior shift (Due to Impaction)</li>\n<li>Posterior Tilt</li>\n<li>Proximal shift</li>\n<li>Medial shift/ Tilt</li>\n<li>Internal rotation</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/nXS78u9gtcN9XWxtcjBI1747376371.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Type 1:</strong> Undisplaced fracture</li>\n<li><strong>Type 2:</strong> Partially displaced <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> with <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of only <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> cortex</li>\n<li><strong>Type 3:</strong> Completely displaced <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> cortex.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe elbow pain, swelling, deformity, and loss of function may occur, and neurological symptoms like weakness in wrist <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> or the <strong>\"hand of benediction\"</strong> sign may also occur if the<strong> <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> nerve</strong> is affected.</li>\n<li>Unusual <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"ebc4d593fd1692777196b50a4faad4\">prominence</span> of the <span class=\"customMeta\" data-dictid=\"42c351f10a1692777194fbc64fc061\">olecranon</span> in the backward tilt <strong>(S-shaped deformity)</strong></li>\n<li>The skin around the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> has a dimpled appearance <strong>(Dimple sign)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>X-ray Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Three bony parts relationship is maintained.</li>\n<li><strong>Fat Pad or Sail sign: </strong>A <span class=\"customMeta\" data-dictid=\"4537d6e7e216927772007d067522aa\">translucent</span> shadow-like appearance representing <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> fat pads.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Dr Graham Lloyd-Jones\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.radiologymasterclass.co.uk/gallery/trauma/x-ray_arm_1/fractures_8\" data-tags=\"\" height=\"335\" src=\"https://image.prepladder.com/content/RUQz6N83bEtkSfiWI1ne1747376378.png\" width=\"296\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Disturbed tear drop sign:</strong> An <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> appearance of the fat pad, suggesting the presence of an injury, such as a <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> or joint effusion.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/PA4i6ct6OhKCPDW9xxyE1747376391.png\" width=\"500\"/></p>\n<p> </p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Mous A, Hacking C, Campos A\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/supracondylar-humeral-fracture-2\" data-tags=\"\" height=\"323\" src=\"https://image.prepladder.com/content/lyCFGmXDoKkuJOvzYPZC1747376406.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p> </p>\n<ul>\n<li><strong>Fishtail sign: </strong>The ends of the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> fragment are slightly widened and serrated, resembling a fishtail<strong>.</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD, Diego Delso\" data-hash=\"\" data-license=\"CC BY-SA 3.0, CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Supracondylar_humerus_fracture#/media/File:Supracondylar09.JPG, https://en.wikipedia.org/wiki/Common_dentex#/media/File:Dent%C3%B3n_com%C3%BAn_(Dentex_dentex),_franja_marina_Teno-Rasca,_Tenerife,_Espa%C3%B1a,_2022-01-08,_DD,_DD_64.jpg\" data-tags=\"\" height=\"340\" src=\"https://image.prepladder.com/content/SobJbK3Y6EYz0JdaAHx81747376428.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Crescent sign: </strong>The normal <span class=\"customMeta\" data-dictid=\"17825c11c616927771979bd9b0b285\">radiolucent</span> gap of the <span class=\"customMeta\" data-dictid=\"3fead70a341692777187431ed9d5e0\">elbow joint</span> is replaced by a crescent-shaped shadow from the <span class=\"customMeta\" data-dictid=\"2f2b8ee27316927771830e8372cc12\">capitulum</span> overlapping the olecranon, indicating <span class=\"customMeta\" data-dictid=\"5cdf29eaf516927772012b4a16cde1\">varus</span> or <span class=\"customMeta\" data-dictid=\"e33d939e82169277720167f59b0ee2\">valgus</span> tilt of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> fragment.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Leonardo Lustosa\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/supracondylar-fracture-gartland-type-i-2\" data-tags=\"\" height=\"654\" src=\"https://image.prepladder.com/content/9GoVUbWIVhFEbR53rbqd1747376443.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Based on the type of fracture</p>\n<ul>\n<li><strong>Undisplaced fracture: </strong>Immobilisation in above-elbow <span class=\"customMeta\" data-dictid=\"6c22f2390016927771955c0c04b851\">plaster</span> slab with the elbow in 90-degree flexion.</li>\n<li><strong>Displaced fractures</strong>\n<ul>\n<li>Closed reduction with <span class=\"customMeta\" data-dictid=\"b2fb1a3a5416927771953ea4fa15e1\">percutaneous</span> K-wire fixation. (for Type 2 fracture)</li>\n<li>Open reduction internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> with K-wire. (for Type 3 fracture)</li>\n</ul>\n</li>\n<li><strong>In Late presentation with swelling</strong>\n<ul>\n<li>Dunlop <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> (skin)</li>\n<li>Smith <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> (skeletal)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Early complications</strong>\n<ul>\n<li>Vascular injury (commonly Brachial artery)</li>\n<li>Nerve injury (commonly <strong>Anterior Interosseous nerve</strong>)</li>\n</ul>\n</li>\n<li><strong>Delayed complications</strong>\n<ul>\n<li><strong>Cubitus <span class=\"customMeta\" data-dictid=\"5cdf29eaf516927772012b4a16cde1\">varus</span> or Gunstock <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> (Malunion) (Option C)</strong></li>\n<li>Volkmann's Ischemia and <span class=\"customMeta\" data-dictid=\"ce3edddb5116927771844c030f3c1e\">compartment</span> syndrome.</li>\n<li>Elbow stiffness</li>\n<li>Myositis ossificans.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following is seen in the terrible triad of elbow, except.", "options": [{"label": "A", "text": "Elbow dislocation", "correct": false}, {"label": "B", "text": "Radial head fracture", "correct": false}, {"label": "C", "text": "Fracture of the olecranon", "correct": true}, {"label": "D", "text": "Fracture of the coronoid process of ulna", "correct": false}], "correct_answer": "C. Fracture of the olecranon", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/TYfhdR2RrPdvoDbpU1UJ1747376740.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following fractures does the three point bony relationship is maintained?", "options": [{"label": "A", "text": "Lateral epicondyle fracture", "correct": false}, {"label": "B", "text": "Medial epicondyle fracture", "correct": false}, {"label": "C", "text": "Elbow dislocation", "correct": false}, {"label": "D", "text": "Supracondylar fracture", "correct": true}], "correct_answer": "D. Supracondylar fracture", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/MOB4uVjcjznU1U0bA36a1745990887.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the name of the test performed in the image given below?", "options": [{"label": "A", "text": "Allen's test", "correct": true}, {"label": "B", "text": "Adson test", "correct": false}, {"label": "C", "text": "Barbeau test", "correct": false}, {"label": "D", "text": "Homans test", "correct": false}], "correct_answer": "A. Allen's test", "question_images": ["https://image.prepladder.com/content/0U526IcCcGMpRCO3JFMD1745992653.png"], "explanation_images": ["https://image.prepladder.com/content/WBX8Dl7OWnKMuhm1YZ7D1745992714.png", "https://image.prepladder.com/content/CTdtvu73ISPXY48GV2TX1745907499.png", "https://image.prepladder.com/content/81XG2xIl1XJ64gw7bRcZ1745907581.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the emergency room, a 40-year-old male patient arrived with a complaint of pain and swelling in the right shoulder region following a fall. The patient's X-ray indicates a tear in which of the following ligaments?", "options": [{"label": "A", "text": "Coracoclavicular ligament", "correct": false}, {"label": "B", "text": "Acromioclavicular ligament", "correct": false}, {"label": "C", "text": "Both the above", "correct": true}, {"label": "D", "text": "Glenohumeral ligament", "correct": false}], "correct_answer": "C. Both the above", "question_images": ["https://image.prepladder.com/content/ZwKthyJtGRfLMmwGbwbS1745907873.png"], "explanation_images": ["https://image.prepladder.com/content/sRNbgxrTZvOygxua1S5g1745992783.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Acute <span class=\"customMeta\" data-dictid=\"af5636ad4f1692777180f49bd0956a\">acromioclavicular</span> (AC) joint injury, commonly following direct trauma; includes sprains, subluxations, and dislocations.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fall on the shoulder with arm adducted leading to <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> strain or tear. Severe forces may cause complete dislocation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Type I:</strong> AC <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> sprain; joint remains undisplaced.</li>\n<li><strong>Type II:</strong> AC ligaments torn; joint subluxated with slight <span class=\"customMeta\" data-dictid=\"2cb340bacd169277718404028c7d00\">clavicle</span> elevation.</li>\n<li><strong>Type III:</strong> <strong>AC and <span class=\"customMeta\" data-dictid=\"6d3b667b0c16927771855ae3ed3a2b\">coracoclavicular</span> ligaments torn</strong>; joint dislocated, visible step deformity.<strong> (Option C)</strong></li>\n<li>Type IV: <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> <span class=\"customMeta\" data-dictid=\"2cb340bacd169277718404028c7d00\">clavicle</span> displacement.</li>\n<li>Type V: Marked upward <span class=\"customMeta\" data-dictid=\"2cb340bacd169277718404028c7d00\">clavicle</span> displacement.</li>\n<li>Type VI: <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">Inferior</span> <span class=\"customMeta\" data-dictid=\"2cb340bacd169277718404028c7d00\">clavicle</span> <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> beneath the coracoid.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Signs: Pain, bruising, and <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> at the injury site. Visible ‘step’ in cases of dislocation.</li>\n<li>Movement: Limited shoulder movement with severe pain in dislocation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Views: Anteroposterior, <span class=\"customMeta\" data-dictid=\"3b78d9438716927771841c88afb16c\">cephalic</span> tilt, and axillary views are recommended. Stress view may <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> <span class=\"customMeta\" data-dictid=\"bd04ba63bc1692777201f54e0ee060\">Type II</span> vs Type III.</li>\n<li><strong>Stress View: </strong>Measure the distance between the <span class=\"customMeta\" data-dictid=\"6d706ad0a916927771852098e31258\">coracoid</span> and clavicle; &gt;50% difference indicates dislocation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sprains/Subluxations: Rest in a sling, pain subsides within a week, followed by shoulder exercises.</li>\n<li>Dislocations: Techniques include <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> or <span class=\"customMeta\" data-dictid=\"2cb340bacd169277718404028c7d00\">clavicle</span> excision.</li>\n<li>Post-surgery Rehab: Elbow/forearm exercises day after surgery, shoulder movements 2 weeks later. Avoid strenuous lifting for 4–6 months.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following ribs is fractured in the X-ray given below?", "options": [{"label": "A", "text": "3", "correct": false}, {"label": "B", "text": "4", "correct": false}, {"label": "C", "text": "6", "correct": true}, {"label": "D", "text": "7", "correct": false}], "correct_answer": "C. 6", "question_images": ["https://image.prepladder.com/content/KKqIXFLRDwv3A9tVOOaf1745992393.png"], "explanation_images": ["https://image.prepladder.com/content/fwfMKsXtBENUCFJg2c6h1745992499.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 11-year-old patient presents with an outward angulation of the forearm in relation to the upper arm . The patient reports occasional discomfort and limitation in the range of motion of the affected arm. What is the most likely diagnosis for this patient's condition?", "options": [{"label": "A", "text": "Cubitus varus", "correct": false}, {"label": "B", "text": "Cubitus valgus", "correct": true}, {"label": "C", "text": "Gunstock deformity", "correct": false}, {"label": "D", "text": "Coxa vara", "correct": false}], "correct_answer": "B. Cubitus valgus", "question_images": ["https://image.prepladder.com/content/j4hA1AprYytbfKB9XI8W1692878873.png"], "explanation_images": ["https://image.prepladder.com/content/kexyOhpcdjgxuiJbvuIs1711619639.png", "https://image.prepladder.com/content/aBb2896U1aKshZClwH4Z1711619679.png"], "explanation": "<p>Correct option B - &lt;span class=\"customMeta\" data-dictid=\"5a7668926a1692777185299ac4cf5a\"&gt;Cubitus&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"e33d939e82169277720167f59b0ee2\"&gt;valgus&lt;/span&g\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Cubitus valgus</strong></td>\n<td>Outward <span class=\"customMeta\" data-dictid=\"1aec9f83db16927771815b94ad8e86\">angulation</span> of the <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> in relation to the upper arm</td>\n</tr>\n<tr>\n<td><strong>Cubitus varus</strong></td>\n<td>Inward <span class=\"customMeta\" data-dictid=\"1aec9f83db16927771815b94ad8e86\">angulation</span> of the <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> in relation to the upper arm</td>\n</tr>\n<tr>\n<td><strong>Gunstock deformity</strong></td>\n<td>\n<ul>\n<li>Inward <span class=\"customMeta\" data-dictid=\"1aec9f83db16927771815b94ad8e86\">angulation</span> of the <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> due to a <span class=\"customMeta\" data-dictid=\"e9c1a7fec316927771915c5460d9a7\">malunion</span> of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> after a fracture</li>\n<li>The <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> appears bent, resembling the shape of a gunstock</li>\n</ul>\n<p><img src=\"https://image.prepladder.com/content/kexyOhpcdjgxuiJbvuIs1711619639.png\" style=\"height:897px; width:673px\"/></p>\n</td>\n</tr>\n<tr>\n<td><strong>Coxa vara</strong></td>\n<td>Decrease in the angle between the head and neck of the <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> leading to an inward <span class=\"customMeta\" data-dictid=\"1aec9f83db16927771815b94ad8e86\">angulation</span> of the thigh bone</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What condition is shown in the image?", "options": [{"label": "A", "text": "Biceps tendon rupture", "correct": true}, {"label": "B", "text": "Triceps muscle rupture", "correct": false}, {"label": "C", "text": "Humerus fracture", "correct": false}, {"label": "D", "text": "Tennis elbow", "correct": false}], "correct_answer": "A. Biceps tendon rupture", "question_images": ["https://image.prepladder.com/content/rCA7qK8JJ1oxotswww2W1692691070.jpeg"], "explanation_images": [], "explanation": "<p>Correct option A - &lt;span class=\"customMeta\" data-dictid=\"6b395fd7b21692777183cf78e12920\"&gt;Biceps&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\"&gt;tendon&lt;/span&gt; ruptu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following nerve is damaged in the picture of the patient given below?", "options": [{"label": "A", "text": "Radial nerve", "correct": true}, {"label": "B", "text": "Ulnar nerve", "correct": false}, {"label": "C", "text": "Median nerve", "correct": false}, {"label": "D", "text": "Axillary nerve", "correct": false}], "correct_answer": "A. Radial nerve", "question_images": ["https://image.prepladder.com/content/9dmfDQiZI74K7rCY5Zsw1692690868.png"], "explanation_images": ["https://image.prepladder.com/content/HVylnXNYTvDil6gZpS3O1711618367.png", "https://image.prepladder.com/content/d5xMPPMejiCOH6bUXnJP1711618390.png"], "explanation": "<p>Correct option A - &lt;span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\"&gt;Radial&lt;/span&gt; nerv\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"text-align:center\"><strong>Nerve Injury</strong></td>\n</tr>\n<tr>\n<td><strong>Radial nerve</strong></td>\n<td>\n<p>Wrist drop</p>\n<p><img src=\"https://image.prepladder.com/content/HVylnXNYTvDil6gZpS3O1711618367.png\" style=\"height:522px; width:495px\"/></p>\n</td>\n</tr>\n<tr>\n<td><strong>Ulnar nerve</strong></td>\n<td>\n<p>Claw hand</p>\n<p><img src=\"https://image.prepladder.com/content/d5xMPPMejiCOH6bUXnJP1711618390.png\" style=\"height:521px; width:290px\"/></p>\n</td>\n</tr>\n<tr>\n<td><strong>Median nerve</strong></td>\n<td>Paraesthesia of thumb, index and middle finger</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What does a positive Trendelenburg gait not indicate in terms of involvement among the following?", "options": [{"label": "A", "text": "Gluteus medius", "correct": false}, {"label": "B", "text": "Sciatic nerve", "correct": true}, {"label": "C", "text": "Gluteus minimus", "correct": false}, {"label": "D", "text": "Superior gluteal nerve", "correct": false}], "correct_answer": "B. Sciatic nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/5j9yZRzWEAd0uTa3Fr331745991257.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a tear in the anteroinferior aspect of the glenoid capsule and the labrum. What is the likely diagnosis for this type of lesion?", "options": [{"label": "A", "text": "Hill-Sachs lesion", "correct": false}, {"label": "B", "text": "Bankart's lesion", "correct": true}, {"label": "C", "text": "Both A and B", "correct": false}, {"label": "D", "text": "Osteolytic lesion", "correct": false}], "correct_answer": "B. Bankart's lesion", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ay1YOfmYU5ncq3JgL45v1745990703.png", "https://image.prepladder.com/content/tvVLioiHxXbMPXUE8Amm1745990703.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Bankart <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hill-Sachs <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> (Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tear in <strong>anteroinferior aspect</strong> of the <span class=\"customMeta\" data-dictid=\"7649bd0f191692777188dcdf91af69\">glenoid</span> <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> and labrum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Posterolateral defect</strong> in <strong>head of the <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> (Bony defect)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"390\" src=\"https://image.prepladder.com/content/ay1YOfmYU5ncq3JgL45v1745990703.png\" width=\"249\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Samir Benoudina\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/hill-sachs-lesion-16?lang=us\" data-tags=\"\" height=\"346\" src=\"https://image.prepladder.com/content/tvVLioiHxXbMPXUE8Amm1745990703.png\" width=\"311\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old patient presented to the Outpatient Department (OPD) with an u pper limb deformity. An X-ray image is provided. What is the most probable fracture responsible for this deformity?", "options": [{"label": "A", "text": "Supracondylar Fracture", "correct": true}, {"label": "B", "text": "Olecranon Fracture", "correct": false}, {"label": "C", "text": "Radial Head fracture", "correct": false}, {"label": "D", "text": "Triad of elbow", "correct": false}], "correct_answer": "A. Supracondylar Fracture", "question_images": ["https://image.prepladder.com/content/05GDStbh8sZInRmRzq201713873547.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Supracondylar Fractu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "While performing a Histamine test on an individual with an injury to the trunk of brachial plexus , you can expect ___________.", "options": [{"label": "A", "text": "Central capillary dilation → wheal → Surrounding flare", "correct": false}, {"label": "B", "text": "Central capillary dilation → Wheal without surrounding flare", "correct": true}, {"label": "C", "text": "Central capillary dilation → Wheal with exaggerated surrounding flare", "correct": false}, {"label": "D", "text": "Absent Triple Response", "correct": false}], "correct_answer": "B. Central capillary dilation → Wheal without surrounding flare", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Central &lt;span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\"&gt;capillary&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\"&gt;dilation&lt;/span&gt; → &lt;span class=\"customMeta\" data-dictid=\"e5af50c97116927772022c9af96a3c\"&gt;Wheal&lt;/span&gt; without surrounding\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old man involved in a fight injured his finger and presented with the deformity as shown in the following image. His X-ray is normal. The most appropriate management of the given condition at this stage is:", "options": [{"label": "A", "text": "Splint the finger in flexion", "correct": false}, {"label": "B", "text": "Buddy strapping", "correct": false}, {"label": "C", "text": "Surgical repair of the flexor tendon", "correct": false}, {"label": "D", "text": "Splint the finger in hyperextension", "correct": true}], "correct_answer": "D. Splint the finger in hyperextension", "question_images": ["https://image.prepladder.com/content/ULUIaRNEaaeOeoDVi6eJ1688015260.png"], "explanation_images": ["https://image.prepladder.com/content/e8g1Lz6LI5t4oVKxlfZD1713873702.png", "https://image.prepladder.com/content/IQyQTwnxMiKKb7efFpv61713873778.png", "https://image.prepladder.com/content/MrGw18VuUNbMU9S5Zsk91713873800.png", "https://image.prepladder.com/content/BlQoTKjZMiKGaUnQYOD71713873821.png"], "explanation": "<p>Correct Option D - Splint the finger in h\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to the emergency department after he fell on his outstretched hand. An X-ray was performed and is given below. What is the diagnosis?", "options": [{"label": "A", "text": "Colle's fracture", "correct": false}, {"label": "B", "text": "Rolando's fracture", "correct": false}, {"label": "C", "text": "Galeazzi fracture", "correct": true}, {"label": "D", "text": "Montegia fracture", "correct": false}], "correct_answer": "C. Galeazzi fracture", "question_images": ["https://image.prepladder.com/content/3qoHVII2k0IMZXMlDDUs1713874905.png"], "explanation_images": [], "explanation": "<p>Correct Option C\n<table>\n<tbody>\n<tr>\n<td>\n<p>Colle's fracture</p>\n</td>\n<td>\n<p>Fracture of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> with <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> angulation</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Rolando's fracture</p>\n</td>\n<td>\n<p>Comminuted <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of the base of the thumb</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Galeazzi fracture</p>\n</td>\n<td>\n<p>Fracture of the <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> with <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"6c5e87b03d1692777197e1150ae78a\">radioulnar</span> joint</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Montegia fracture</p>\n</td>\n<td>\n<p>Fracture of the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> third of the <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> with <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of the <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The test performed in the following image is", "options": [{"label": "A", "text": "Allen's test", "correct": true}, {"label": "B", "text": "Roos test", "correct": false}, {"label": "C", "text": "Adson's test", "correct": false}, {"label": "D", "text": "Wright test", "correct": false}], "correct_answer": "A. Allen's test", "question_images": ["https://image.prepladder.com/content/SMVwnWKdjOalWrhFMDC01688455456.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the following fracture?", "options": [{"label": "A", "text": "Colles Fracture", "correct": false}, {"label": "B", "text": "Monteggia Fracture", "correct": true}, {"label": "C", "text": "Barton's Fracture", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "B. Monteggia Fracture", "question_images": ["https://image.prepladder.com/content/Fq3unid4WmRilPLxBecu1713874332.png"], "explanation_images": ["https://image.prepladder.com/content/4b25O3dV08uYsM59CuAv1700128690.png", "https://image.prepladder.com/content/U3BLeFsm7KRyBdNCUqb81700128834.png"], "explanation": "<p>Correct Option B - Monteggia Fractu\n<table>\n<tbody>\n<tr>\n<td><strong>Definition</strong></td>\n<td>Monteggia <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> is a type of <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> involving a <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> or middle third of the <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> with <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of the <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head. It was first described by Giovanni Battista Monteggia.</td>\n</tr>\n<tr>\n<td><strong>Anatomy Involved</strong></td>\n<td>Fracture of the <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> (usually the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> or middle third). - <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">Dislocation</span> of the <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head.</td>\n</tr>\n<tr>\n<td><strong>Mechanism of Injury</strong></td>\n<td>Typically results from a direct blow to the <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> or a fall on an outstretched hand. - Force is transmitted along the forearm, causing the <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> and <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head dislocation.</td>\n</tr>\n<tr>\n<td><strong>Clinical Presentation</strong></td>\n<td><strong>Deformity:</strong> <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> <span class=\"customMeta\" data-dictid=\"1aec9f83db16927771815b94ad8e86\">angulation</span> of the fractured <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> may be visible.- <strong>Pain:</strong> <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">Localized</span> pain at the site of the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> and dislocation. - <strong>Limited Range of Motion:</strong> Restricted <span class=\"customMeta\" data-dictid=\"d3daf86e63169277719936e262ff26\">supination</span> and <span class=\"customMeta\" data-dictid=\"189ee8a22a1692777196b04278555f\">pronation</span> of the forearm.</td>\n</tr>\n<tr>\n<td><strong>Classification</strong></td>\n<td><strong>Bado Classification:</strong> Classifies Monteggia Fractures based on the direction of the <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> and associated <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> pattern (Types I-IV).</td>\n</tr>\n<tr>\n<td><strong>Diagnostic Imaging</strong></td>\n<td>X-rays of the <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of the <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> and the dislocated <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head. - CT scans may be used for more detailed assessment.</td>\n</tr>\n<tr>\n<td><strong>Treatment</strong></td>\n<td><strong>Closed Reduction:</strong> Attempted for certain cases with early presentation and minimal displacement. - <strong>Open Reduction and Internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">Fixation</span> (ORIF):</strong> <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> intervention may be required for more complex fractures or cases not amenable to closed reduction.</td>\n</tr>\n<tr>\n<td><strong>Complications</strong></td>\n<td><strong>Malunion:</strong> Improper <span class=\"customMeta\" data-dictid=\"3c0c325f4216927771819e5d0eb581\">alignment</span> of the fractured bones. - <strong>Nonunion:</strong> Failure of the fractured bones to heal. - <strong>Radial Nerve Injury:</strong> Possible nerve injury associated with the fracture.</td>\n</tr>\n<tr>\n<td><strong>Rehabilitation</strong></td>\n<td>Initiated post-surgery or after <span class=\"customMeta\" data-dictid=\"da014870171692777184980beab405\">closed reduction</span> to restore <span class=\"customMeta\" data-dictid=\"069cba94231692777197b41e753795\">range of motion</span> and strength. - Physical therapy is often a crucial component.</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old woman comes to the emergency department after a road traffic accident. She was a non-restrained passenger in a car. She has pain in her neck and difficulty in neck movements. She has no associated neurological deficits. A neck collar is applied to protect the spinal cord. An X-ray of the neck is shown in the image below. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Hangman fracture", "correct": true}, {"label": "B", "text": "Jefferson's fracture", "correct": false}, {"label": "C", "text": "Clay shoveler fracture", "correct": false}, {"label": "D", "text": "Sciwora", "correct": false}], "correct_answer": "A. Hangman fracture", "question_images": ["https://image.prepladder.com/content/kXzG1LcPTb9786LDQaj01713874262.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Hangman Fractu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the carpal bone that is most commonly fractured after fall on an outstretched hand .", "options": [{"label": "A", "text": "A", "correct": true}, {"label": "B", "text": "C", "correct": false}, {"label": "C", "text": "B", "correct": false}, {"label": "D", "text": "D", "correct": false}], "correct_answer": "A. A", "question_images": ["https://image.prepladder.com/content/wS337L07Z3aiXFthXw1F1713873361.png"], "explanation_images": ["https://image.prepladder.com/content/AMhCKi7wozIft1mQwVZx1713873389.png", "https://image.prepladder.com/content/EwCUcuHzFu3ZySHWocja1713873405.png"], "explanation": "<p>Correct Option A - A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following options is not linked to Sprengel deformity?", "options": [{"label": "A", "text": "Diastematomyelia", "correct": false}, {"label": "B", "text": "Klippel-Feil syndrome", "correct": false}, {"label": "C", "text": "Dextrocardia", "correct": true}, {"label": "D", "text": "Congenital scoliosis", "correct": false}], "correct_answer": "C. Dextrocardia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - D\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The following images A and B show?", "options": [{"label": "A", "text": "Mallet finger &amp;amp; Jersey finger", "correct": false}, {"label": "B", "text": "Boxer fracture &amp;amp; march fracture", "correct": false}, {"label": "C", "text": "Mallet finger &amp;amp; boxer fracture", "correct": false}, {"label": "D", "text": "Jersey finger &amp;amp; baseball finger", "correct": true}], "correct_answer": "D. Jersey finger &amp; baseball finger", "question_images": ["https://image.prepladder.com/content/GrmdCaGSYyNRhIaWiR961695560591.png"], "explanation_images": [], "explanation": "<p>Correct Option D - Jersey finger &amp;amp; baseball fing\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Hand Injury</strong></p>\n</td>\n<td>\n<p><strong>Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Gamekeeper's Thumb</p>\n</td>\n<td>\n<p>Injury to the<strong> <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (UCL) of the thumb</strong>, usually resulting from a <strong>forceful <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> or <span class=\"customMeta\" data-dictid=\"2ad2fb4cc8169277718925a677620c\">hyperextension</span> of the thumb</strong>.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Mallet Finger</p>\n</td>\n<td>\n<p>Injury to the <strong>extensor <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> of the finger, specifically at the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> (DIP) joint.</strong> This injury is often caused by a forceful blow to the fingertip or by forcefully jamming the finger.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Jersey Finger</p>\n</td>\n<td>\n<p>Injury to the <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> of the finger, specifically at the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> (DIP) joint. It occurs when the <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> is torn or avulsed from its <span class=\"customMeta\" data-dictid=\"ccd357daaf16927771825777ea6a0d\">attachment</span> to the bone, typically due to forceful extension of the finger while it is actively flexed, such as when trying to grab an opponent's jersey in sports.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Trigger Finger</p>\n</td>\n<td>\n<p>A condition characterized by the <strong>inflammation and narrowing of the <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> <span class=\"customMeta\" data-dictid=\"44e9c0bbec169277719829907370ee\">sheath</span> in the finger. </strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Boxer's Fracture</p>\n</td>\n<td>\n<p>A <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of the <span class=\"customMeta\" data-dictid=\"3582e886271692777192ab233546a6\">metacarpal</span> bone in the hand, specifically the<strong> neck of the metacarpal. </strong>It usually results from a direct impact with a closed fist, such as during a punch.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following best describes the condition known as \"painful arc syndrome\"?", "options": [{"label": "A", "text": "A condition in which joint stiffness lasts for more than 30 minutes in the morning, affecting multiple joints.", "correct": false}, {"label": "B", "text": "A condition characterized by localized, sharp pain at the site of an injury or inflammation.", "correct": false}, {"label": "C", "text": "A condition where pain is experienced during a specific range of motion, typically between 60 and 120 degrees of shoulder abduction.", "correct": true}, {"label": "D", "text": "A condition marked by generalized musculoskeletal pain, fatigue, and tender points in various areas of the body.", "correct": false}], "correct_answer": "C. A condition where pain is experienced during a specific range of motion, typically between 60 and 120 degrees of shoulder abduction.", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - A condition where pain is experienced during a specific range of motion, typically between 60 and 120 degrees of shoulder abdu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following fractures is most prone to non-union?", "options": [{"label": "A", "text": "Proximal scaphoid", "correct": true}, {"label": "B", "text": "Inter-trochanteric", "correct": false}, {"label": "C", "text": "Distal radius", "correct": false}, {"label": "D", "text": "Talar neck", "correct": false}], "correct_answer": "A. Proximal scaphoid", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vw0VLCPeuEPlEC9mMXY31687772482.png", "https://image.prepladder.com/content/SG1r5aMKgcvIdqWZbZdn1687772482.png"], "explanation": "<p>Correct Option A - Proximal Scaph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The diagnosis of the given image", "options": [{"label": "A", "text": "Scapho lunate instability", "correct": true}, {"label": "B", "text": "Lunate injury", "correct": false}, {"label": "C", "text": "Distal radio ulnar joint instability", "correct": false}, {"label": "D", "text": "Wrist dislocation", "correct": false}], "correct_answer": "A. Scapho lunate instability", "question_images": ["https://image.prepladder.com/content/p51gD8geXdeuzGVe3cMu1713874225.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Scapho &lt;span class=\"customMeta\" data-dictid=\"2c800b393f1692777191e260e94f78\"&gt;Lunate&lt;/span&gt; I\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25 year old man fell down while running. He tried to sustain the fall on his elbow resulting in the injury shown below. What will be the appropriate management of the following fracture ?", "options": [{"label": "A", "text": "Above elbow plaster slab", "correct": false}, {"label": "B", "text": "Below elbow plaster slab", "correct": false}, {"label": "C", "text": "Close reduction with Tension band wiring", "correct": false}, {"label": "D", "text": "Immobilization of elbow, Above elbow plaster slab with 30 degree flexion", "correct": true}], "correct_answer": "D. Immobilization of elbow, Above elbow plaster slab with 30 degree flexion", "question_images": ["https://image.prepladder.com/content/OJepkaoxm6BWy2eicWjd1713874188.png"], "explanation_images": [], "explanation": "<p>Correct Option D - Immobilization of elbow, Above elbow &lt;span class=\"customMeta\" data-dictid=\"6c22f2390016927771955c0c04b851\"&gt;plaster&lt;/span&gt; slab with 30 deg\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Three point bony relationship has a diagnostic value in:", "options": [{"label": "A", "text": "Elbow fracture", "correct": true}, {"label": "B", "text": "Monteggia fracture", "correct": false}, {"label": "C", "text": "Galeazzi fracture", "correct": false}, {"label": "D", "text": "Colles' fracture", "correct": false}], "correct_answer": "A. Elbow fracture", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Elbow Fractu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-year-old child complaining of pain and swelling is suspected with supracondylar fracture of right hand (Undisplaced) . X-ray of right elbow was not significant. What is the next best step in this case?", "options": [{"label": "A", "text": "Compare with X-ray of left hand", "correct": false}, {"label": "B", "text": "Immobilisation and above the elbow plaster slab (90 degree flexion)", "correct": true}, {"label": "C", "text": "Closed reduction with K wire fixation Cast", "correct": false}, {"label": "D", "text": "Cast", "correct": false}], "correct_answer": "B. Immobilisation and above the elbow plaster slab (90 degree flexion)", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Immobilisation and above the elbow &lt;span class=\"customMeta\" data-dictid=\"6c22f2390016927771955c0c04b851\"&gt;plaster&lt;/span&gt; slab (90 degree flexion)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A Post-menopausal women slipped and fell down on an outstretched hand in the washroom. X-ray of her distal forearm is given below. Diagnose the following condition?", "options": [{"label": "A", "text": "Colle's Fracture", "correct": true}, {"label": "B", "text": "Montaggiea fracture", "correct": false}, {"label": "C", "text": "Smith Fracture", "correct": false}, {"label": "D", "text": "Galeazzi fracture", "correct": false}], "correct_answer": "A. Colle's Fracture", "question_images": ["https://image.prepladder.com/content/AmuCW6dvGrOshMHEGuVi1691375592.jpg"], "explanation_images": [], "explanation": "<p>Correct Option A - Colle's Fracture:</p>\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Fracture Name</strong></p>\n</td>\n<td>\n<p><strong>Characteristic Findings</strong></p>\n</td>\n<td>\n<p><strong>Sites Involved</strong></p>\n</td>\n<td>\n<p><strong>Special History</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Colles' Fracture</p>\n</td>\n<td>\n<p>Dorsal <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> radius</p>\n</td>\n<td>\n<p>Distal radius</p>\n</td>\n<td>\n<p>Falling on an outstretched hand</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Smith's Fracture</p>\n</td>\n<td>\n<p>Volar <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> radius</p>\n</td>\n<td>\n<p>Distal radius</p>\n</td>\n<td>\n<p>Falling on a flexed wrist</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Monteggia Fracture</p>\n</td>\n<td>\n<p>Proximal <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> with <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head dislocation</p>\n</td>\n<td>\n<p>Proximal ulna, <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head</p>\n</td>\n<td>\n<p>Direct blow to the <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> or forearm</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Galeazzi Fracture</p>\n</td>\n<td>\n<p>Distal <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> with <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"6c5e87b03d1692777197e1150ae78a\">radioulnar</span> joint dislocation</p>\n</td>\n<td>\n<p>Distal radius, <span class=\"customMeta\" data-dictid=\"6c5e87b03d1692777197e1150ae78a\">radioulnar</span> joint</p>\n</td>\n<td>\n<p>Fall on an outstretched hand with an <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> deviation</p>\n</td>\n</tr>\n</tbody>\n\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Fracture Name</strong></p>\n</td>\n<td>\n<p><strong>Characteristic Findings</strong></p>\n</td>\n<td>\n<p><strong>Sites Involved</strong></p>\n</td>\n<td>\n<p><strong>Special History</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Colles' Fracture</p>\n</td>\n<td>\n<p>Dorsal <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> radius</p>\n</td>\n<td>\n<p>Distal radius</p>\n</td>\n<td>\n<p>Falling on an outstretched hand</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Smith's Fracture</p>\n</td>\n<td>\n<p>Volar <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> radius</p>\n</td>\n<td>\n<p>Distal radius</p>\n</td>\n<td>\n<p>Falling on a flexed wrist</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Monteggia Fracture</p>\n</td>\n<td>\n<p>Proximal <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> with <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head dislocation</p>\n</td>\n<td>\n<p>Proximal ulna, <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head</p>\n</td>\n<td>\n<p>Direct blow to the <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> or forearm</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Galeazzi Fracture</p>\n</td>\n<td>\n<p>Distal <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> with <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"6c5e87b03d1692777197e1150ae78a\">radioulnar</span> joint dislocation</p>\n</td>\n<td>\n<p>Distal radius, <span class=\"customMeta\" data-dictid=\"6c5e87b03d1692777197e1150ae78a\">radioulnar</span> joint</p>\n</td>\n<td>\n<p>Fall on an outstretched hand with an <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> deviation</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Nightstick Fracture</p>\n</td>\n<td>\n<p>Isolated <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of the <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> shaft</p>\n</td>\n<td>\n<p>Midshaft ulna</p>\n</td>\n<td>\n<p>Direct blow to the forearm</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Barton's Fracture</p>\n</td>\n<td>\n<p>Fracture of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> with <span class=\"customMeta\" data-dictid=\"f953c828ea16927771909cb3a51e36\">intra-articular</span> extension</p>\n</td>\n<td>\n<p>Distal radius</p>\n</td>\n<td>\n<p>Falling onto a pronated or supinated wrist</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Essex-Lopresti Fracture</p>\n</td>\n<td>\n<p>Radial head <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> associated with <span class=\"customMeta\" data-dictid=\"6c5e87b03d1692777197e1150ae78a\">radioulnar</span> dissociation</p>\n</td>\n<td>\n<p>Radial head, <span class=\"customMeta\" data-dictid=\"6c5e87b03d1692777197e1150ae78a\">radioulnar</span> joint</p>\n</td>\n<td>\n<p>Axial load transmitted through the forearm</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Assertion: Proximal pole of scaphoid is the most common bone to undergo avascular necrosis Reason : Blood supply is retrograde from its distal to proximal end", "options": [{"label": "A", "text": "Both assertion and reason are true and the reason is the correct explanation for the assertion", "correct": true}, {"label": "B", "text": "Both assertion and reason are true, but the reason is correct not the correct explanation for the assertion", "correct": false}, {"label": "C", "text": "Assertion is true, but the reason is false", "correct": false}, {"label": "D", "text": "Assertion is false, but the reason is true", "correct": false}, {"label": "E", "text": "Both assertion is and reason are false", "correct": false}], "correct_answer": "A. Both assertion and reason are true and the reason is the correct explanation for the assertion", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following statements are correct about anterior shoulder dislocation except :", "options": [{"label": "A", "text": "Recurrence rate is maximum if the patients age less than 20 years", "correct": false}, {"label": "B", "text": "Axillary nerve is most commonly injured", "correct": false}, {"label": "C", "text": "CT scan is preferred for knowing the bony lesion", "correct": true}, {"label": "D", "text": "Anterior shoulder dislocation is most common typeof shoulder dislocation,", "correct": false}], "correct_answer": "C. CT scan is preferred for knowing the bony lesion", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with swelling and tenderness in the anatomical snuffbox after sustaining a fall on their outstretched hand. The X-ray image is given below. Identify the fracture.", "options": [{"label": "A", "text": "Colles fracture", "correct": false}, {"label": "B", "text": "Scaphoid fracture", "correct": true}, {"label": "C", "text": "Smith fracture", "correct": false}, {"label": "D", "text": "Galeazzi fracture", "correct": false}], "correct_answer": "B. Scaphoid fracture", "question_images": ["https://image.prepladder.com/content/qW7q4hDYJyreJrjcP0Yj1691232761.png"], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"4992469b3c169277719874a6808793\"&gt;Scaphoid&lt;/span&gt; Fractu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 66 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 27</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Upper Limb Traumatology-Upper Limb Trauma-I - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 27</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 27 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 55-year-old female fell on her left shoulder while walking and now presents with severe pain, swelling, and bruising. Based on the X-ray shown below, what is the most common mechanism of injury and the likely affected structure?", "options": [{"label": "A", "text": "Direct trauma, Axillary nerve", "correct": false}, {"label": "B", "text": "Fall on an outstretched hand, Radial nerve", "correct": false}, {"label": "C", "text": "Direct trauma, Radial nerve", "correct": false}, {"label": "D", "text": "Fall on an outstretched hand, Axillary nerve", "correct": true}], "correct_answer": "D. Fall on an outstretched hand, Axillary nerve", "question_images": ["https://image.prepladder.com/notes/ShroIJXaf5z8Ajq9ONHo1743682513.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:715px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Proximal <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">Humerus</span> Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Shaft of <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">Humerus</span> Fracture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fall on an outstretched hand <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Direct trauma <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structures affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Axillary artery</li>\n<li>Axillary nerve <strong>(Option D)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Brachial artery</li>\n<li>Radial nerve <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Joint <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> (most common)</strong></li>\n<li>Avascular <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> (AVN)</li>\n<li>Nerve injury:\n\t\t\t\t<ul>\n<li><strong>Axillary nerve (most common)</strong></li>\n<li>Suprascapular nerve injury</li>\n</ul>\n</li>\n<li>Non-union</li>\n<li>Shoulder dislocation</li>\n<li>Myositis</li>\n<li>Malunion</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early: </strong></p>\n<ul>\n<li>Nerve injury: <strong>Radial nerve (wrist drop)</strong></li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Late: </strong></p>\n<ul>\n<li>Delayed and non-union</li>\n<li>Joint stiffness</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/3QMbyEVdDel4yPMkiCpM1743161861.mp3", "video": ""}, {"text": "A 34-year-old female presents to the emergency department with severe pain and swelling in her right forearm after a biking accident. She has difficulty flexing her ring and pinky fingers. Examination reveals swelling, limited flexion of the fourth and fifth fingers, pallor, diminished pulse, and paresthesia in the affected fingers. What is the appropriate management?", "options": [{"label": "A", "text": "Turn Buckle’s Splint", "correct": true}, {"label": "B", "text": "Max Page’s Operation", "correct": false}, {"label": "C", "text": "Seddon’s Carpectomy", "correct": false}, {"label": "D", "text": "Amputation", "correct": false}], "correct_answer": "A. Turn Buckle’s Splint", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/dWRhpWkj6JXw3gcs4PVm1737936434.png", "https://image.prepladder.com/content/6taHajillPpS2G8SbhUo1737936471.png", "https://image.prepladder.com/content/MtsN84aeJqTswP2O8Cad1737936507.png", "https://image.prepladder.com/content/8AChV65eLjF2LhxKWGYO1737936581.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:755px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mild </strong></p>\n<p><strong>(Tsuge's Type-I)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Turn Buckle's <span class=\"customMeta\" data-dictid=\"7f606f911b1692777199eb69ab67c5\">splint</span> (Volkmann's splinting) </strong><strong>(Option A)</strong></li>\n</ul>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/dWRhpWkj6JXw3gcs4PVm1737936434.png\" width=\"500\"/></p>\n\t\t\t \n\n\t\t\t<ul>\n<li>Physiotherapy</li>\n<li>Total <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> (single muscle involved)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate </strong></p>\n<p><strong>(Tsuge's Type-II)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Max page's operation (Soft tissue sliding operation) </strong><strong>(Option B)</strong></li>\n</ul>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"372\" src=\"https://image.prepladder.com/content/6taHajillPpS2G8SbhUo1737936471.png\" width=\"500\"/></p>\n<p> </p>\n<ul>\n<li>Excision of cicatrix</li>\n<li>Neurolysis (freeing the <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> nerves from the surrounding <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> tissue)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severe </strong></p>\n<p><strong>(Tsuge's Type-III)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Seddon's carpectomy: </strong><strong>(Option C)</strong></li>\n</ul>\n<p> </p>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"306\" src=\"https://image.prepladder.com/content/MtsN84aeJqTswP2O8Cad1737936507.png\" width=\"500\"/></p>\n<p><img alt=\"\" data-author=\"Seungbae Oh, Hyun Woo Park, Soo-Hwan Kang, Dohyung Lim, Il-Jung Park \" data-hash=\"\" data-license=\"CC BY NC 4.0\" data-source=\"https://onlinelibrary.wiley.com/doi/10.1111/os.13776\" data-tags=\"\" height=\"372\" src=\"https://image.prepladder.com/content/8AChV65eLjF2LhxKWGYO1737936581.png\" width=\"500\"/></p>\n<ul>\n<li>Excision of the scar</li>\n<li>Arthrodesis of the wrist</li>\n<li>Amputation (cases with gangrene) <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/osKuYMICvVmDjGp7A7N51743161592.mp3", "video": ""}, {"text": "A 28-year-old female with a history of a left lateral condylar fracture presents with left elbow pain, especially during lifting or reaching overhead. She notices her left arm appears straighter than her right. Examination shows lateral deviation of the forearm when her arms are extended. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Gunstock deformity", "correct": false}, {"label": "B", "text": "Cubitus valgus", "correct": true}, {"label": "C", "text": "Dinner fork deformity", "correct": false}, {"label": "D", "text": "Coxa vara", "correct": false}], "correct_answer": "B. Cubitus valgus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/FnsrCWHK9ChVX82G6UhS1737935791.png", "https://image.prepladder.com/content/m6CNRyLlarUy9S3IhF7F1737935873.png", "https://image.prepladder.com/notes/Mk48tVT4nB7PK2J8o7vT1744216978.png", "https://image.prepladder.com/content/OFKOX815BjQVZRJ1w8rl1737935992.png", "https://image.prepladder.com/content/05qmJ1vP4sSfICM47xwi1737936068.png", "https://image.prepladder.com/content/R7oaPiqo80gaQxoqHcHh1737936103.png", "https://image.prepladder.com/content/LrTaoMb7VsP5a1dLusUD1737936166.png", "https://image.prepladder.com/content/3aGM06Xse7qZtn3iVBuz1737936242.png", "https://image.prepladder.com/content/0emvoIk3vzQknvY2fda31737936273.png", "https://image.prepladder.com/content/Lc74PHmeEwjsTN4mWkrh1737936308.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:735px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">acquired</span> <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> growth on the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> side of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> humeral epiphysis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-union of <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> condylar fracture</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A carrying angle of the elbow greater than 15 degrees</li>\n<li>Asymmetry between the two side</li>\n<li>Lateral <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> of the <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> during arm extension</li>\n</ul>\n<p><img alt=\"\" data-author=\"Özkan, Cenk &amp; Deveci, Mehmet &amp; Tekin, Mustafa &amp; Bicer, Omer &amp; Gökçe, Kadir &amp; Gulsen, Mahir. \" data-hash=\"\" data-license=\"CC BY-NC ND 4.0\" data-source=\"https://www.researchgate.net/figure/Eleven-year-old-girl-with-cubitus-valgus-deformity-patient-6-a-Clinical-appearance_fig3_309296874\" data-tags=\"\" height=\"372\" src=\"https://image.prepladder.com/content/FnsrCWHK9ChVX82G6UhS1737935791.png\" width=\"500\"/></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Usually, no treatment is required</li>\n<li>Supracondylar <span class=\"customMeta\" data-dictid=\"d1ed4aacdf1692777194c9aa2fc2ac\">osteotomy</span> (in severe cases)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complication </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tardy <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve palsy: Managed by <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"ca580d88d51692777200a2792a4b06\">transposition</span> of the <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve.</strong></p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:722px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> closed <span class=\"customMeta\" data-dictid=\"b3c25aa68616927772025ab4ff7a11\">wedge</span> osteotomy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Approach </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"8fcc203d6c16927772007de57cf5b4\">triceps</span> split</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"629\" src=\"https://image.prepladder.com/content/3aGM06Xse7qZtn3iVBuz1737936242.png\" width=\"500\"/></p>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/0emvoIk3vzQknvY2fda31737936273.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"CC BY 2.5\" data-hash=\"\" data-license='\"Amit K Srivastava Dc Srivastava Sc Gaur\"' data-source=\"https://www.researchgate.net/figure/Radiograph-anteroposterior-view-a-Preoperative-showing-cubitus-varus-deformity-b_fig1_26811208\" data-tags=\"\" height=\"1025\" src=\"https://image.prepladder.com/content/Lc74PHmeEwjsTN4mWkrh1737936308.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indication </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cubitus <span class=\"customMeta\" data-dictid=\"5cdf29eaf516927772012b4a16cde1\">varus</span> correction</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/DY62yO3KfGaaUeCnjvwi1743161351.mp3", "video": ""}, {"text": "A 7-year-old boy is brought to the emergency department after falling from a tree. X-rays reveal a displaced supracondylar fracture of the humerus. The child is experiencing severe pain, and upon examination, the forearm appears swollen and tense. Which of the following is the first sign of impending compartment syndrome??", "options": [{"label": "A", "text": "Absence of the radial pulse on examination", "correct": false}, {"label": "B", "text": "Pain that intensifies with passive finger extension", "correct": true}, {"label": "C", "text": "Immediate improvement in pain with elevation of the arm", "correct": false}, {"label": "D", "text": "Numbness of the forearm", "correct": false}], "correct_answer": "B. Pain that intensifies with passive finger extension", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/CEnnOZopcJkfFJy5AjhH1737935653.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/USYfGYwiE1EZPs8sLaOZ1743161096.mp3", "video": ""}, {"text": "A 28-year-old male presents to the emergency department after a fall while playing rugby. He has severe pain and swelling in his elbow, and the physician suspects injury to the terrible triad. Which of the following is NOT a component of the terrible triad of the elbow?", "options": [{"label": "A", "text": "Posterior elbow dislocation", "correct": false}, {"label": "B", "text": "Fracture of the radial head", "correct": false}, {"label": "C", "text": "Fracture of the coronoid process", "correct": false}, {"label": "D", "text": "Fracture of the medial epicondyle", "correct": true}], "correct_answer": "D. Fracture of the medial epicondyle", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/epsAI2wod9LvPruVlU581737935513.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/bcORw6vI4nkVIepXYSJK1743160867.mp3", "video": ""}, {"text": "A 7-year-old child presents to the emergency department after falling on an outstretched hand. The examination reveals swelling and tenderness over the lateral aspect of the elbow. X-rays show the findings as shown in the image. What classification system is used to categorize this condition?", "options": [{"label": "A", "text": "Pauwel’s Classification", "correct": false}, {"label": "B", "text": "Garden Classification", "correct": false}, {"label": "C", "text": "Milch Classification", "correct": true}, {"label": "D", "text": "Gustilo-Anderson Classification", "correct": false}], "correct_answer": "C. Milch Classification", "question_images": ["https://image.prepladder.com/content/EYAUDSX7iupNFnwnyeu51737935350.png"], "explanation_images": ["https://image.prepladder.com/content/h0jHI9xsgUJpXkCA4WGn1737935408.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/x3MijSDKUvqjaLvmz4rn1743158049.mp3", "video": ""}, {"text": "A 10-year-old patient presents to the emergency department after falling onto an outstretched hand. X-rays reveal a finding, as shown in the image. Traction is applied as part of the management, as depicted in the accompanying image. What is the name of the traction being used?", "options": [{"label": "A", "text": "Dunlop traction", "correct": true}, {"label": "B", "text": "Russell traction", "correct": false}, {"label": "C", "text": "Gallow traction", "correct": false}, {"label": "D", "text": "Perkins traction", "correct": false}], "correct_answer": "A. Dunlop traction", "question_images": ["https://image.prepladder.com/notes/cfH9fZhLL8KNNoHWvVfd1743682855.png", "https://image.prepladder.com/content/7twzjtljQ11gyq6e4QrD1737934985.png"], "explanation_images": ["https://image.prepladder.com/content/1nLBODsTlhoOLjbV7cuv1737935112.png", "https://image.prepladder.com/content/oEKT7WHny9LuGIJvY1em1737935159.png", "https://image.prepladder.com/content/bN1B4YLb6Y8G0enlKiO41737935204.png", "https://image.prepladder.com/content/bRV8vSDjiM2ATxoW0Xrn1737935276.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8cFmPxbqZywKV0PpPy6Y1743157706.mp3", "video": ""}, {"text": "A 6-year-old child presents to the emergency department after falling onto an outstretched hand. X-ray shows the following findings. What is the most appropriate management?", "options": [{"label": "A", "text": "Long arm cast immobilization for 3 weeks", "correct": false}, {"label": "B", "text": "Closed reduction and casting", "correct": false}, {"label": "C", "text": "Closed reduction and percutaneous pinning", "correct": true}, {"label": "D", "text": "Open reduction and internal fixation", "correct": false}], "correct_answer": "C. Closed reduction and percutaneous pinning", "question_images": ["https://image.prepladder.com/content/v810tQUScsUdtW7diPAV1738143715.png"], "explanation_images": ["https://image.prepladder.com/content/bXioyztqek3JoE3ttEoF1737934693.png", "https://image.prepladder.com/content/b736U1ei1HK3JqzepoPf1737934732.png", "https://image.prepladder.com/content/pioHR8nwbJfG0YQvnBd31737934813.png", "https://image.prepladder.com/content/2CUGU2xRcnQEp8o2MEgR1737934880.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gartland <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> of <span class=\"customMeta\" data-dictid=\"043a86fa0016927771998a67e65e6a\">Supracondylar</span> Fractures</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nondisplaced fractures.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Long arm cast immobilisation</strong></p>\n<p><strong>(Option A)</strong> for 3 weeks, followed by a period of protected activity</p>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/b736U1ei1HK3JqzepoPf1737934732.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type II</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fracture with an intact <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> hinge.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type IIA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stable fractures with no significant</p>\n<p>translation or rotation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Closed reduction &amp; <span class=\"customMeta\" data-dictid=\"8c6ba9ffab1692777183324e3a5ed3\">casting</span> <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type IIB</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unstable fractures with some degree of translation or rotation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Closed reduction and <span class=\"customMeta\" data-dictid=\"b2fb1a3a5416927771953ea4fa15e1\">percutaneous</span> K-wire fixation</p>\n<p><img alt=\"\" data-author=\"Ramji Lal Sahu\" data-hash=\"\" data-license=\"CC BY-NC SA 3.0\" data-source=\"https://www.researchgate.net/figure/a-Pre-operative-A-P-and-Lateral-radiographs-showing-Supracondylar-fracture-of-humerus_fig1_259631537\" data-tags=\"\" height=\"585\" src=\"https://image.prepladder.com/content/pioHR8nwbJfG0YQvnBd31737934813.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Completely displaced fractures.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Closed reduction and pinning</p>\n<p><img alt=\"\" data-author=\"Frederik Greve 1,*,Michael Müller 1ORCID,Markus Wurm 1,Peter Biberthaler 1,Georg Singer 2ORCID,Holger Till 2 andHelmut Wegmann 1\" data-hash=\"\" data-license=\"CC BY\" data-source=\"https://www.mdpi.com/2227-9067/9/7/1013\" data-tags=\"\" height=\"535\" src=\"https://image.prepladder.com/content/2CUGU2xRcnQEp8o2MEgR1737934880.png\" width=\"500\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ZBU4e48Yu384vIOECQLK1743157532.mp3", "video": ""}, {"text": "A 9-year-old boy fell on his outstretched hand and was presented with pain, swelling and restricted movement of the elbow, along with an S-shaped deformity. An X-ray was performed; What is the most common type of below fracture diagnosed?", "options": [{"label": "A", "text": "Flexion type, Anteromedial", "correct": false}, {"label": "B", "text": "Extension type, Posterolateral", "correct": false}, {"label": "C", "text": "Flexion type, Anterolateral", "correct": false}, {"label": "D", "text": "Extension type, Posteromedial", "correct": true}], "correct_answer": "D. Extension type, Posteromedial", "question_images": ["https://image.prepladder.com/content/M6qbGJ3BfX5f4bKmISg21737934261.png"], "explanation_images": ["https://image.prepladder.com/content/AwQYsHt8pwk5mRMJdvYm1737934355.png", "https://image.prepladder.com/content/hFMvZUODX073K6mqudGf1737934413.png", "https://image.prepladder.com/content/tGxPwZlONpavg3WMCuDG1737934516.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:611px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extension type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Flexion Type</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Frequency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More common</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare<strong> (Option A and C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> part of the <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> is extended.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> part of the <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> is flexed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subtypes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Posteromedial (more common)</li>\n<li>Posterolateral<strong> (Option B)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Anteromedial</li>\n<li>Anterolateral</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Radial nerve injury </strong>(Posteromedial)</li>\n<li><strong>Median nerve injury </strong>(Posterolateral)</li>\n<li><strong>Vascular injury: </strong>Brachial <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> damage is most common, leading to <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> ischemia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Ulnar nerve injury </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Supracondylar_humerus_fracture#/media/File:Supracondylar09.JPG\" data-tags=\"\" height=\"810\" src=\"https://image.prepladder.com/content/AwQYsHt8pwk5mRMJdvYm1737934355.png\" width=\"500\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Steinman, Suzanne &amp; Bastrom, Tracey &amp; Newton, Peter &amp; Mubarak, Scott. \" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Type-II-flexion-supracondylar-fracture-in-5-year-old-female-case-2-The-patient_fig2_24221696\" data-tags=\"\" height=\"367\" src=\"https://image.prepladder.com/content/hFMvZUODX073K6mqudGf1737934413.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/tGxPwZlONpavg3WMCuDG1737934516.png\" width=\"500\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/2S7VGFPBntzslAaaCRaa1743156974.mp3", "video": ""}, {"text": "An 18-year-old male presents with difficulty flexing the distal phalanx of her index and middle fingers, along with weakness in thumb opposition and forearm pronation. He also reports pain, swelling, and limited movement in his elbow following a fall on his left hand. An X-ray was taken. Which of the following nerves is commonly affected in this condition?", "options": [{"label": "A", "text": "Radial nerve", "correct": false}, {"label": "B", "text": "Posterior interosseous nerve", "correct": false}, {"label": "C", "text": "Ulnar nerve", "correct": false}, {"label": "D", "text": "Anterior interosseous nerve", "correct": true}], "correct_answer": "D. Anterior interosseous nerve", "question_images": ["https://image.prepladder.com/content/d3LG7ka1O5Bw71AElHx91737933635.png"], "explanation_images": ["https://image.prepladder.com/content/Bf5V5fU6xZZ7C2sFdD6W1737933706.png", "https://image.prepladder.com/content/5EzwqpKFf14m8DFytnIK1737933745.png", "https://image.prepladder.com/content/OqINqU6LYWHO5GC17NOw1737933799.png", "https://image.prepladder.com/content/OoOExAXIOlKmAdQnECAJ1737933947.png", "https://image.prepladder.com/content/j0CKqMDi4hKWkfsbfvgz1737933872.png", "https://image.prepladder.com/content/j0MH7cwdBHOAPmgO1omY1737933986.png", "https://image.prepladder.com/content/vVTz81WdmHdQpWeer8DZ1737934047.png"], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Reference:</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:638px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Supracondylar Fractures </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fall on outstretched hand (FOOSH)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Humerus fractures just above the condyles.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Displacements</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> fragment of the <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> is usually displaced by</p>\n<ul>\n<li>Posterior shift (Due to Impaction)</li>\n<li>Posterior Tilt</li>\n<li>Proximal shift</li>\n<li>Medial shift/ Tilt</li>\n<li>Internal rotation</li>\n</ul>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/Bf5V5fU6xZZ7C2sFdD6W1737933706.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Type 1:</strong> Undisplaced fracture</li>\n<li><strong>Type 2:</strong> Partially displaced <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> with <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of only <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> cortex</li>\n<li><strong>Type 3:</strong> Completely displaced <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> cortex.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe elbow pain, swelling, deformity, and loss of function may occur, and neurological symptoms like weakness in wrist <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> or the <strong>\"hand of benediction\"</strong> sign may also occur if the<strong> <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> nerve</strong> is affected.</li>\n<li>Unusual <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"ebc4d593fd1692777196b50a4faad4\">prominence</span> of the <span class=\"customMeta\" data-dictid=\"42c351f10a1692777194fbc64fc061\">olecranon</span> in the backward tilt <strong>(S-shaped deformity)</strong></li>\n<li>The skin around the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> has a dimpled appearance <strong>(Dimple sign)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Three bony parts relationship is maintained.</li>\n<li><strong>Fat Pad or Sail sign: </strong>A <span class=\"customMeta\" data-dictid=\"4537d6e7e216927772007d067522aa\">translucent</span> shadow-like appearance representing <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> fat pads.</li>\n</ul>\n<p><img alt=\"\" data-author=\"Hellerhoff \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Fat_pad_sign#/media/File:Fettpolsterzeichen_pathologisch_Ellenbogen.png\" data-tags=\"\" height=\"517\" src=\"https://image.prepladder.com/content/5EzwqpKFf14m8DFytnIK1737933745.png\" width=\"500\"/></p>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Disturbed tear drop sign:</strong> An <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> appearance of the fat pad, suggesting the presence of an injury, such as a <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> or joint effusion.</li>\n</ul>\n<p><img alt=\"\" data-author=\"Hellerhoff \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Supracondylar_process_of_the_humerus#/media/File:Processus_supracondylaris.jpg\" data-tags=\"\" height=\"558\" src=\"https://image.prepladder.com/content/OqINqU6LYWHO5GC17NOw1737933799.png\" width=\"500\"/></p>\n\t\t\t <img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/OoOExAXIOlKmAdQnECAJ1737933947.png\" width=\"500\"/>\n<ul>\n<li><strong>Fishtail sign: </strong>The ends of the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> fragment are slightly widened and serrated, resembling a fishtail<strong>.</strong></li>\n</ul>\n<p><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Supracondylar_humerus_fracture#/media/File:Supracondylar09.JPG\" data-tags=\"\" height=\"583\" src=\"https://image.prepladder.com/content/j0CKqMDi4hKWkfsbfvgz1737933872.png\" width=\"500\"/></p>\n\t\t\t <img alt=\"\" data-author=\"Diego Delso\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Common_dentex#/media/File:Dent%C3%B3n_com%C3%BAn_(Dentex_dentex),_franja_marina_Teno-Rasca,_Tenerife,_Espa%C3%B1a,_2022-01-08,_DD,_DD_64.jpg\" data-tags=\"\" height=\"793\" src=\"https://image.prepladder.com/content/j0MH7cwdBHOAPmgO1omY1737933986.png\" width=\"500\"/>\n<ul>\n<li><strong>Crescent sign: </strong>The normal <span class=\"customMeta\" data-dictid=\"17825c11c616927771979bd9b0b285\">radiolucent</span> gap of the <span class=\"customMeta\" data-dictid=\"3fead70a341692777187431ed9d5e0\">elbow joint</span> is replaced by a crescent-shaped shadow from the <span class=\"customMeta\" data-dictid=\"2f2b8ee27316927771830e8372cc12\">capitulum</span> overlapping the olecranon, indicating <span class=\"customMeta\" data-dictid=\"5cdf29eaf516927772012b4a16cde1\">varus</span> or <span class=\"customMeta\" data-dictid=\"e33d939e82169277720167f59b0ee2\">valgus</span> tilt of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> fragment.</li>\n</ul>\n<p><img alt=\"\" data-author=\"Leonardo Lustosa\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/supracondylar-fracture-gartland-type-i-2\" data-tags=\"\" height=\"654\" src=\"https://image.prepladder.com/content/vVTz81WdmHdQpWeer8DZ1737934047.png\" width=\"500\"/></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Based on the type of fracture</p>\n<ul>\n<li><strong>Undisplaced fracture: </strong>Immobilisation in above-elbow <span class=\"customMeta\" data-dictid=\"6c22f2390016927771955c0c04b851\">plaster</span> slab with the elbow in 90-degree flexion.</li>\n<li><strong>Displaced fractures</strong>\n<ul>\n<li>Closed reduction with <span class=\"customMeta\" data-dictid=\"b2fb1a3a5416927771953ea4fa15e1\">percutaneous</span> K-wire fixation. (for <span class=\"customMeta\" data-dictid=\"05e8c1df0d1692777201c9acee8b1f\">Type 2</span> fracture)</li>\n<li>Open reduction internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> with K-wire. (for <span class=\"customMeta\" data-dictid=\"6f809a27121692777201d1ccde5ace\">Type 3</span> fracture)</li>\n</ul>\n</li>\n<li><strong>In Late presentation with swelling</strong>\n<ul>\n<li>Dunlop <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> (skin)</li>\n<li>Smith <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> (skeletal)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Early complications</strong>\n<ul>\n<li>Vascular injury (commonly <span class=\"customMeta\" data-dictid=\"1e4db8b6ad1692777183683f42d44b\">Brachial</span> artery)</li>\n<li>Nerve injury (commonly <strong>Anterior <span class=\"customMeta\" data-dictid=\"72b8cffc701692777190c03a6968ab\">Interosseous</span> nerve</strong>)</li>\n</ul>\n</li>\n<li><strong>Delayed complications</strong>\n<ul>\n<li><strong>Cubitus <span class=\"customMeta\" data-dictid=\"5cdf29eaf516927772012b4a16cde1\">varus</span> or Gunstock <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> (Malunion)</strong></li>\n<li>Volkmann's <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">Ischemia</span> and <span class=\"customMeta\" data-dictid=\"ce3edddb5116927771844c030f3c1e\">compartment</span> syndrome.</li>\n<li>Elbow stiffness</li>\n<li>Myositis ossificans.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/LdgowHAYVfSpimHUQgad1743156606.mp3", "video": ""}, {"text": "An 11-year-old girl is brought to the clinic after falling on her outstretched hand, resulting in severe pain in her left elbow. The examination shows swelling and tenderness in the elbow, and she is reluctant to move her arm. An x-ray has been taken. Which of the following is false regarding the 3 bony point relationship in this fracture?", "options": [{"label": "A", "text": "Three points form a nearly isosceles triangle when the elbow is flexed at 90°.", "correct": false}, {"label": "B", "text": "Medial epicondyle, lateral epicondyle, and tip of the olecranon are the three bony points.", "correct": false}, {"label": "C", "text": "Bony relationship is unaffected by elbow fractures.", "correct": true}, {"label": "D", "text": "Bony point relationship are unaffected in Supracondylar fractures", "correct": false}], "correct_answer": "C. Bony relationship is unaffected by elbow fractures.", "question_images": ["https://image.prepladder.com/content/wrf0tRLcbW3ScqeffRjI1737933239.png"], "explanation_images": ["https://image.prepladder.com/content/AOAunWW3lZxpmCzynPGt1737933332.png", "https://image.prepladder.com/content/G2q8t2nN3p1IIrptnn8O1737933515.png", "https://image.prepladder.com/content/eg5kmuTigeHPlVxntJmw1737933437.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:653px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Supracondylar Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Elbow Dislocation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Frequency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> in children</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> in children</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fall on outstretched hand, hyperextension</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fall on outstretched hand, <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> force on flexed elbow</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Three bony points relationship</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maintained</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reversed <strong>(Option B)</strong><br/>\n<strong>(Bowstringing of <span class=\"customMeta\" data-dictid=\"8fcc203d6c16927772007de57cf5b4\">Triceps</span> tendon)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Length of forearm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Shorter</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gartland <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">classification</span> (3 types: I, II, III)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No specific classification</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nerve damage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anterior <span class=\"customMeta\" data-dictid=\"72b8cffc701692777190c03a6968ab\">interosseous</span> nerve</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Median nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anterior humeral line displaced, visible fracture.</p>\n<p><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Supracondylar_humerus_fracture#/media/File:Supracondylar09.JPG\" data-tags=\"\" height=\"822\" src=\"https://image.prepladder.com/content/G2q8t2nN3p1IIrptnn8O1737933515.png\" width=\"500\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dislocation of <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> and <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> with displaced humeral condyle.</p>\n<img alt=\"\" data-author=\"Kian\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://wikem.org/wiki/File:Elbow_dislocation_lateral.jpg\" data-tags=\"\" height=\"714\" src=\"https://image.prepladder.com/content/eg5kmuTigeHPlVxntJmw1737933437.png\" width=\"500\"/><br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications and Deformities</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Compartment syndrome (Volkmann's ischemic contracture)</li>\n<li>Brachial <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> injury</li>\n<li><strong>Gunstock <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> (cubitus varus)</strong> in untreated cases.</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Medial <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (MCL)</strong> or <strong>lateral <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (LCL)</strong> damage resulting in <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> dislocations or subluxations.</li>\n<li>Posterior <span class=\"customMeta\" data-dictid=\"42c351f10a1692777194fbc64fc061\">olecranon</span> <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> (abnormal <span class=\"customMeta\" data-dictid=\"ebc4d593fd1692777196b50a4faad4\">prominence</span> of the <strong>olecranon process)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5HK6y90l5wVOOCFeJrvp1743156474.mp3", "video": ""}, {"text": "A 30-year-old male presents to the emergency department with severe pain in his left upper arm and wrist drop after a fall while playing football. Examination reveals weakness in wrist extension and numbness over the dorsum of his hand. Radiographs show a humeral fracture. Which part of the humerus is most likely involved in this fracture?", "options": [{"label": "A", "text": "Supracondylar region", "correct": false}, {"label": "B", "text": "Junction of the middle and distal third", "correct": true}, {"label": "C", "text": "Junction of the proximal and middle third", "correct": false}, {"label": "D", "text": "Surgical neck of the humerus", "correct": false}], "correct_answer": "B. Junction of the middle and distal third", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/N8eN9sj2nTWtgAwKMOQN1737933123.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/0lnVsieYUrKyKNFf50MF1743156172.mp3", "video": ""}, {"text": "A 48-year-old female fell on her outstretched right hand and reported shoulder pain. A bruise was noted during the examination, and an X-ray was performed. How would you classify this fracture according to Neer's classification based on the X-ray findings?", "options": [{"label": "A", "text": "One-part fracture", "correct": false}, {"label": "B", "text": "Three-part fracture", "correct": false}, {"label": "C", "text": "Four-part fracture", "correct": false}, {"label": "D", "text": "Two-part fracture", "correct": true}], "correct_answer": "D. Two-part fracture", "question_images": ["https://image.prepladder.com/content/y65hZCuJ4GpVngQFiWnK1737932475.png"], "explanation_images": ["https://image.prepladder.com/content/zDBwZQq7yeM1YJBpbGun1737932542.png", "https://image.prepladder.com/content/c1LI3uzL8EFHh7xfzUX61737932615.png", "https://image.prepladder.com/content/uWhVDlYrUrF4fH1KUyzJ1737932652.png", "https://image.prepladder.com/content/knsvUpdmBWWkPobP4Aii1737932902.png", "https://image.prepladder.com/content/5kfXcUPeVFE9dsB4zImP1737932940.png", "https://image.prepladder.com/content/uposZfEDtt1ps7nJeVWJ1737932735.png", "https://image.prepladder.com/content/zMpzk68Kszjb9RM6yRbn1737932789.png", "https://image.prepladder.com/content/NUGaBR0E9FFupIBPxVzC1737932977.png", "https://image.prepladder.com/content/1bEjRQPmEIh9VJxHmi6e1737932847.png", "https://image.prepladder.com/content/mjnDAUpWVZdO8b3JlBKo1737933009.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:632px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neer’s Classification</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1 Part Fracture</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> line involves 1 part and no displacement.</p>\n<p><img alt=\"\" data-author='\"R.W. Jordan Chetan S Modi\"' data-hash=\"\" data-license=\"CC BY 2.5\" data-source=\"https://www.researchgate.net/figure/Proximal-humeral-fractures-according-to-Neer-Classification-a-One-part-b-Two-part-c_fig1_264396460\" data-tags=\"\" height=\"518\" src=\"https://image.prepladder.com/content/uWhVDlYrUrF4fH1KUyzJ1737932652.png\" width=\"500\"/></p>\n<p> </p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Conservative with an arm <span class=\"customMeta\" data-dictid=\"5e2a7b127c1692777198f4895cc7c0\">sling</span> for 6 weeks, followed by exercises.</p>\n\t\t\t \n\n\t\t\t<ul>\n<li>Triangular arm sling</li>\n</ul>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/knsvUpdmBWWkPobP4Aii1737932902.png\" width=\"500\"/></p>\n<p> </p>\n\t\t\t \n\n\t\t\t<ul>\n<li>Velpeau bandage</li>\n</ul>\n<p> </p>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/5kfXcUPeVFE9dsB4zImP1737932940.png\" width=\"500\"/><br/>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2 Part Fracture</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> line involves two parts and <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of 1 part.</p>\n<img alt=\"\" data-author='\"R.W. Jordan Chetan S Modi\"' data-hash=\"\" data-license=\"CC BY 2.5\" data-source=\"https://www.researchgate.net/figure/Proximal-humeral-fractures-according-to-Neer-Classification-a-One-part-b-Two-part-c_fig1_264396460\" data-tags=\"\" height=\"482\" src=\"https://image.prepladder.com/content/uposZfEDtt1ps7nJeVWJ1737932735.png\" width=\"500\"/></td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Surgical neck displacement:</strong> <strong>Closed reduction and <span class=\"customMeta\" data-dictid=\"3024d9916e16927771896f5b7159b6\">immobilization</span> with arm-sling </strong>or <strong>k-wire</strong>.</li>\n<li><strong>Greater <span class=\"customMeta\" data-dictid=\"3292cfbbdb169277720182a7b986e4\">tuberosity</span> displaced</strong> (mostly associated with shoulder dislocation): <span class=\"customMeta\" data-dictid=\"61e4fc8326169277719471f9c16b02\">Open reduction</span> and internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> (ORIF).</li>\n<li><strong>In <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> neck fractures,</strong>\n<ul>\n<li><strong>Older patients: </strong>Hemiarthroplasty (replacement of the humeral head)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3 Part Fracture</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> line involves 3 parts and <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of 2 parts.</p>\n<img alt=\"\" data-author='\"R.W. Jordan Chetan S Modi\"' data-hash=\"\" data-license=\"CC BY 2.5\" data-source=\"https://www.researchgate.net/figure/Proximal-humeral-fractures-according-to-Neer-Classification-a-One-part-b-Two-part-c_fig1_264396460\" data-tags=\"\" height=\"537\" src=\"https://image.prepladder.com/content/zMpzk68Kszjb9RM6yRbn1737932789.png\" width=\"500\"/><br/>\n\t\t\t </td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Open reduction and internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> (ORIF) with <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">Proximal</span> <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> <span class=\"customMeta\" data-dictid=\"1f3ac88f5e169277719047640e36bf\">interlocking</span> system plate <strong>(PHILOS).</strong></p>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/NUGaBR0E9FFupIBPxVzC1737932977.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4 Part Fracture</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> line involves all 4 parts and <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of 3 parts.</p>\n<p>(High chances of <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> necrosis).</p>\n<p><img alt=\"\" data-author='\"R.W. Jordan Chetan S Modi\"' data-hash=\"\" data-license=\"CC BY 2.5\" data-source=\"https://www.researchgate.net/figure/Proximal-humeral-fractures-according-to-Neer-Classification-a-One-part-b-Two-part-c_fig1_264396460\" data-tags=\"\" height=\"490\" src=\"https://image.prepladder.com/content/1bEjRQPmEIh9VJxHmi6e1737932847.png\" width=\"500\"/></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arthroplasty </strong>with <span class=\"customMeta\" data-dictid=\"f0cdc42a0c1692777198f54a380826\">shoulder joint</span> replacement.</p>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/mjnDAUpWVZdO8b3JlBKo1737933009.png\" width=\"500\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/VHyGtubOPrEKBsd2eWwp1743155919.mp3", "video": ""}, {"text": "A 29-year-old boxer received a blow to his arm and presented to the emergency department with severe pain, swelling, and deformity in his left upper arm. He reports difficulty moving his elbow and hand and weakness in his wrist. An X-ray was taken. All the following are management options for this condition except?", "options": [{"label": "A", "text": "U-slab", "correct": false}, {"label": "B", "text": "Hanging cast", "correct": false}, {"label": "C", "text": "Velpeau bandage", "correct": true}, {"label": "D", "text": "Plate osteosynthesis", "correct": false}], "correct_answer": "C. Velpeau bandage", "question_images": ["https://image.prepladder.com/content/z5aF6SaWFTg1ly9lGSgq1737932074.png"], "explanation_images": ["https://image.prepladder.com/content/jiU0Yw9v6iQ4TRkkqlDt1737932141.png", "https://image.prepladder.com/content/s8pjTL75xH4qUfLXIFby1737932171.png", "https://image.prepladder.com/content/0E713CQeX0YWhj5axONv1737932201.png", "https://image.prepladder.com/content/oIK1rgMMzpq7ysqiRpok1737932234.png", "https://image.prepladder.com/content/ey28td9zqEoq2WKwpiKj1737932305.png", "https://image.prepladder.com/content/MKHJnJcykrTOqaDqrcrl1737932358.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:672px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Image </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>U-slab</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Supported with a triangular sling</li>\n<li>Moulded on the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> side of the arm (prevent <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> angulation)</li>\n</ul>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/jiU0Yw9v6iQ4TRkkqlDt1737932141.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hanging arm cast</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Used in lower 1/3rd fractures of the humerus</li>\n<li>The limb's weight and the cast provide <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> to keep the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> aligned.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/s8pjTL75xH4qUfLXIFby1737932171.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chest-arm bandage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The arm is strapped to the chest</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/0E713CQeX0YWhj5axONv1737932201.png\" width=\"500\"/></td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:674px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Technique </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Image </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> with plate and screw</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It consists of:</p>\n<ul>\n<li>Compression plate and screws</li>\n<li>Interlocking <span class=\"customMeta\" data-dictid=\"5b22285eec169277719026820db11c\">intramedullary</span> nail or semi-flexible pins</li>\n<li>External fixator</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"M. WalkerB. PalumboB. BadmanJordan P BrooksJeffrey Van GelderenM. Mighell\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.semanticscholar.org/paper/Humeral-shaft-fractures%3A-a-review.-Walker-Palumbo/90df45dbc84a1069b99b1949034285161c902aec/figure/3\" data-tags=\"\" height=\"1155\" src=\"https://image.prepladder.com/content/oIK1rgMMzpq7ysqiRpok1737932234.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> plate <span class=\"customMeta\" data-dictid=\"e0871aaf2316927771941cf3e79af4\">osteosynthesis</span> (MIPO)</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The plate is placed over the <span class=\"customMeta\" data-dictid=\"54a5d46f341692777184ea14c8b94d\">comminution</span> without disturbing the fragments, and no <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> is utilised.</li>\n<li>Fracture <span class=\"customMeta\" data-dictid=\"3c0c325f4216927771819e5d0eb581\">alignment</span> is preserved without compression.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Uğur GönçMesut AtabekKursat TekerA. Tanriöver\" data-hash=\"\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.semanticscholar.org/paper/Minimally-invasive-plate-osteosynthesis-with-PHILOS-G%C3%B6n%C3%A7-Atabek/e0940fb44a568a3c78c4427a7f567d6d362171ab/figure/4\" data-tags=\"\" height=\"635\" src=\"https://image.prepladder.com/content/ey28td9zqEoq2WKwpiKj1737932305.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Russell-Taylors (RT) <span class=\"customMeta\" data-dictid=\"cb2d373f701692777193324602b6fa\">nailing</span> technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>This procedure avoids <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> nerve injury (wrist drop).</p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/MKHJnJcykrTOqaDqrcrl1737932358.png\" width=\"500\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/KLNPycn3w2bfAld16Je11743155789.mp3", "video": ""}, {"text": "A 26-year-old patient presents to the emergency department with severe pain and tenderness after sustaining an injury from a fall. An X-ray of the region is provided below. Considering the mechanisms of injury, what is the most common cause associated with this condition?", "options": [{"label": "A", "text": "Direct injury", "correct": false}, {"label": "B", "text": "Fall onto an outstretched hand", "correct": false}, {"label": "C", "text": "Fall on the shoulder", "correct": true}, {"label": "D", "text": "Fall from a height", "correct": false}], "correct_answer": "C. Fall on the shoulder", "question_images": ["https://image.prepladder.com/content/WHfgKXGUCSb6fLCAg30t1737928249.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/nUE1s0hYPYDjOFLQT6ia1742993497.mp3", "video": ""}, {"text": "A 30-year-old male presents with recurrent shoulder dislocations after playing basketball &amp;amp; shows the attitude as shown in the image. Which of the following tests is specifically used to assess this shoulder instability?", "options": [{"label": "A", "text": "Fulcrum test", "correct": false}, {"label": "B", "text": "Jobe’s test", "correct": false}, {"label": "C", "text": "Sulcus test", "correct": true}, {"label": "D", "text": "Apprehension test", "correct": false}], "correct_answer": "C. Sulcus test", "question_images": ["https://image.prepladder.com/content/uTs0NbtRtLm35Mposoht1737931371.png"], "explanation_images": ["https://image.prepladder.com/content/0mVZhdZkBRnnaXhKcprc1737931880.png", "https://image.prepladder.com/content/FFztTBNToUCfnYoy3fWt1737931417.png", "https://image.prepladder.com/content/PAOgF5u7CZLeFullLERf1737931479.png", "https://image.prepladder.com/content/OzPzgpEa7NnXcLXihf1z1737931534.png", "https://image.prepladder.com/content/OBJxJ8htMx3KAwtCr5YW1737931597.png", "https://image.prepladder.com/content/OCw6Xz8g2XurZm02TfYB1737931662.png", "https://image.prepladder.com/content/I9lxc8osvaU6d4zD6gDP1737931720.png", "https://image.prepladder.com/content/dyPJUkNNrmCD6sJbzaUj1737931756.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:701px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Test </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Image </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Apprehension test</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>With the patient seated or supine, the examiner abducts the arm and externally rotates it. The patient may feel the humeral head about to slip anteriorly, leading to tension and apprehension.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"James, Michael &amp; Kwong, Cory &amp; More, Kristie &amp; LeBlanc, Justin &amp; Ian, Ka &amp; Bois, Aaron.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/A-Anterior-apprehension-test-B-Bony-apprehension-test-For-each-test-the-patient-is_fig2_359641158\" data-tags=\"\" height=\"310\" src=\"https://image.prepladder.com/content/FFztTBNToUCfnYoy3fWt1737931417.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fulcrum test</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>With the patient lying <span class=\"customMeta\" data-dictid=\"b0976ea1fd16927771995d5c700a21\">supine</span> and the arm abducted to 90°, the examiner uses one hand behind the shoulder as a fulcrum to lever the humeral head forward by extending and laterally rotating the arm, leading to immediate apprehension.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"John Kiel\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://wikism.org/File:Shoulder_fulcrum_test.jpeg\" data-tags=\"\" height=\"180\" src=\"https://image.prepladder.com/content/PAOgF5u7CZLeFullLERf1737931479.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Crank test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>With the arm flexed at 90°, the examiner applies an <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> load to the <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> and rotates it while elevating the shoulder.</p>\n<p>A positive test shows pain or a <span class=\"customMeta\" data-dictid=\"ca464f74b616927771847acf6fa00b\">clicking</span> sensation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"John Kiel\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://wikism.org/File:Crank_Test_for_Shoulder_Instability.jpg\" data-tags=\"\" height=\"413\" src=\"https://image.prepladder.com/content/OzPzgpEa7NnXcLXihf1z1737931534.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Jobe’s relocation test (or) Supraspinatus test</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positioning the shoulder at 90° of <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> and 30° of forward <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> with the thumb down, resistance testing reveals supraspinatus weakness, indicating a possible tear or <span class=\"customMeta\" data-dictid=\"78dfa6942216927771971d0733476f\">rotator</span> <span class=\"customMeta\" data-dictid=\"074fda92471692777185c9d613a2ea\">cuff</span> impingement.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"John Kiel\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://wikism.org/File:Jobe_Relocation_Test.jpg\" data-tags=\"\" height=\"717\" src=\"https://image.prepladder.com/content/OBJxJ8htMx3KAwtCr5YW1737931597.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surprise test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In the relocation test, a <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> force is applied to the humeral head and then suddenly released. The test is considered positive if the patient experiences <span class=\"customMeta\" data-dictid=\"c31ab816e01692777181649c694d46\">apprehension</span> or fear of dislocation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"John Kiel\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://wikism.org/File:Jobe_Relocation_Test.jpg\" data-tags=\"\" height=\"765\" src=\"https://image.prepladder.com/content/OCw6Xz8g2XurZm02TfYB1737931662.png\" width=\"500\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5uawOIPQHxQ5EFBHI6Eb1743155472.mp3", "video": ""}, {"text": "A 32-year-old male arrives at the emergency department with severe right shoulder pain after a fall during a workout. His shoulder appears deformed, with swelling and bruising. An orthopaedic manoeuvre is performed, as shown in the image. What is the name of this technique?", "options": [{"label": "A", "text": "Hippocrates technique", "correct": false}, {"label": "B", "text": "Stimson technique", "correct": true}, {"label": "C", "text": "Milch technique", "correct": false}, {"label": "D", "text": "Gallows traction", "correct": false}], "correct_answer": "B. Stimson technique", "question_images": ["https://image.prepladder.com/content/VSaJymJHIgHhS5DtTN6D1737931017.png"], "explanation_images": ["https://image.prepladder.com/content/oGuD8UX8p5nLtYQvC5Pk1737931093.png", "https://image.prepladder.com/content/2rOaHbNHBMIbijKUXCCS1737931060.png", "https://image.prepladder.com/content/bhxCoDyhR44kzVpDOiEc1737931128.png", "https://image.prepladder.com/content/SwVP6Nm6kvFQpl7HyC7i1737931189.png", "https://image.prepladder.com/content/2jxmOiBKV7ozF1u0NALj1737931245.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/jRPBoLWj1Iq772WNhPF21743154021.mp3", "video": ""}, {"text": "A 28-year-old male presents to the emergency after a soccer match with severe right shoulder pain following a fall. He reports a \"pop\" in his shoulder and is unable to lift his arm or touch the opposite shoulder. An X-ray has been taken. What is the appropriate management for this condition?", "options": [{"label": "A", "text": "External rotation → Adduction → Traction → Medial rotation", "correct": false}, {"label": "B", "text": "Traction → Medial rotation → Adduction → External rotation", "correct": false}, {"label": "C", "text": "Traction → External rotation → Adduction → Medial rotation", "correct": true}, {"label": "D", "text": "Medial rotation → Traction → External rotation → Adduction", "correct": false}], "correct_answer": "C. Traction → External rotation → Adduction → Medial rotation", "question_images": ["https://image.prepladder.com/content/gNOTZUKLjTe11CAN3w4c1737930849.png"], "explanation_images": ["https://image.prepladder.com/content/4Lout1kiMF9pesj8hVoh1737930926.png", "https://image.prepladder.com/content/lh7nC6p3HQwQuxagcxZX1738143642.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/xPDASGJYCwGx6vuzcYOf1743086476.mp3", "video": ""}, {"text": "An 18-year-old male presents with severe pain in his right shoulder following a tackle during a rugby match. Upon examination, a loss of normal shoulder contour is noted. Diagnosis of anterior shoulder dislocation was made. What is the most common complication associated with this condition?", "options": [{"label": "A", "text": "Brachial plexus injury", "correct": false}, {"label": "B", "text": "Rotator Cuff tear", "correct": false}, {"label": "C", "text": "Axillary artery injury", "correct": false}, {"label": "D", "text": "Recurrence", "correct": true}], "correct_answer": "D. Recurrence", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:649px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Delayed Complications</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Rotator <span class=\"customMeta\" data-dictid=\"074fda92471692777185c9d613a2ea\">cuff</span> tear</strong> - Common in the elderly due to degenerative changes in the tendons and less common in younger patients. <strong>(Option B)</strong></li>\n<li><strong>Axillary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> injury</strong> - Rare; Occurs with severe trauma <strong>(Option B)</strong></li>\n<li><strong>Nerve injury</strong> - The <strong>axillary nerve </strong>is most commonly affected; other nerve injuries and complete <span class=\"customMeta\" data-dictid=\"1e4db8b6ad1692777183683f42d44b\">brachial</span> <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> are rare. <strong>(Option A)</strong></li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Recurrence</strong> - Most common, due to instability.</li>\n<li><strong>Joint stiffness</strong> - Results from prolonged immobility.</li>\n<li><strong>Unreduced dislocation</strong> - Due to missed or undiagnosed dislocation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/SwGp5MIT3XeJpFJop6eE1743086295.mp3", "video": ""}, {"text": "A 32-year-old male presents to the emergency department after a motorcycle accident with severe pain and immobility in his right shoulder. Examination reveals a flattened shoulder, and he is unable to abduct or externally rotate the arm. An X-ray was taken. What type of dislocation is suspected?", "options": [{"label": "A", "text": "Intrathoracic", "correct": false}, {"label": "B", "text": "Subclavicular", "correct": false}, {"label": "C", "text": "Subglenoid", "correct": false}, {"label": "D", "text": "Subcoracoid", "correct": true}], "correct_answer": "D. Subcoracoid", "question_images": ["https://image.prepladder.com/content/q2f4XdnovlCFJF5opszO1737930405.png"], "explanation_images": ["https://image.prepladder.com/content/MyiLtnSHnDZqgpj7I0oh1737930500.png", "https://image.prepladder.com/content/hbxUkbvpmAinlt2C0y4j1737930613.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:643px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior Shoulder <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subtypes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Subglenoid </strong><strong>(Option C)</strong>: The humeral head lies below the <span class=\"customMeta\" data-dictid=\"7649bd0f191692777188dcdf91af69\">glenoid</span> fossa.</li>\n<li><strong>Subclavicular </strong><strong>(Option B)</strong>: The humeral head is displaced beneath the clavicle.</li>\n<li><strong>Intrathoracic</strong><strong>(Option A)</strong>: The humeral head dislocates into the <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> cavity, which is rare.</li>\n<li><strong>Subcoracoid </strong><strong>(Option D)</strong>: The humeral head lies below the <span class=\"customMeta\" data-dictid=\"6d706ad0a916927771852098e31258\">coracoid</span> process.</li>\n</ul>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/MyiLtnSHnDZqgpj7I0oh1737930500.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Loss of the <span class=\"customMeta\" data-dictid=\"70d60276a81692777185b5f6f71fa9\">deltoid</span> <span class=\"customMeta\" data-dictid=\"21f826cc7316927771858a31dad57d\">contour</span> (loss of shoulder roundness)</li>\n<li>The shoulder is <strong>extended, abducted and externally rotated</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Duga’s test</strong> is the inability to touch the opposite shoulder.</li>\n<li><strong>Hamilton ruler</strong> test is where the gap between the ruler and the arm is lost.</li>\n<li><strong>Callaway’s test</strong> is increased girth of the <span class=\"customMeta\" data-dictid=\"a6218759db1692777182316d0cd2aa\">axilla</span> on the dislocated side.</li>\n<li><strong>Bryant’s Test</strong> is where the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> axillary fold is displaced downward on the affected side.</li>\n<li><strong>Regiment batch sign</strong> is loss of sensation due to axillary nerve damage.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>X-ray reveals that the humeral head is displaced anteriorly and inferiorly, often under the <span class=\"customMeta\" data-dictid=\"6d706ad0a916927771852098e31258\">coracoid</span> process <strong>(\"subcoracoid\" position)</strong></li>\n<li>An MRI is necessary to assess soft-tissue injuries and identify Bankart and Hill-Sachs lesions, which are complications of shoulder dislocations and increase the risk of <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> due to joint instability.</li>\n</ul>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/hbxUkbvpmAinlt2C0y4j1737930613.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Management</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Kocher's method </strong>(Most common method) is the reduction by <strong>traction, external rotation, adduction, and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> rotation.</strong></li>\n<li>In <strong>Hippocrates' method, </strong>the surgeon pulls the semi-abducted arm firmly while using his foot in the <span class=\"customMeta\" data-dictid=\"a6218759db1692777182316d0cd2aa\">axilla</span> as a fulcrum to reduce the dislocation.<strong> </strong></li>\n<li><strong>Stimson’s technique</strong> is the reduction by applying weight for traction, using the body as counter traction.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/bNAaF9mqMdXugAAQhUHr1743076293.mp3", "video": ""}, {"text": "A 36-year-old male with shoulder pain and recurrent anterior dislocations reports instability and weakness during overhead activities. An X-ray is advised. What lesion was observed?", "options": [{"label": "A", "text": "Reverse Bankart lesion", "correct": false}, {"label": "B", "text": "Reverse Hill-Sachs lesion", "correct": false}, {"label": "C", "text": "Bankart lesion", "correct": false}, {"label": "D", "text": "Hill-Sachs lesion", "correct": true}], "correct_answer": "D. Hill-Sachs lesion", "question_images": ["https://image.prepladder.com/notes/UTbkmdCw9HTJMxEUgbzd1743682274.png"], "explanation_images": ["https://image.prepladder.com/content/ZODGX6UoXvooQuKCurRx1737930045.png", "https://image.prepladder.com/content/96N3g3joTzn1EzMoKvDB1737930085.png", "https://image.prepladder.com/content/cqa1sb4JOTuNOxENigPv1737930160.png", "https://image.prepladder.com/content/eeveG9am9OVAIj72cpSx1737930230.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hill-Sachs lesion</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bankart lesion</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reverse Bankart lesion</strong></p>\n<p><strong>(Posterior Bankart)</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reverse Hill-Sachs lesion</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Humeral head</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anterior glenoid</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior glenoid</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Humeral head</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Compression <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> on the <strong>posterolateral </strong>humeral head</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Defect in the <strong>anterior <span class=\"customMeta\" data-dictid=\"b076435f7b1692777191b0f23c2e7e\">labrum</span> </strong>and the <strong>anterior capsule.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tear of the <strong>posterior <span class=\"customMeta\" data-dictid=\"b076435f7b1692777191b0f23c2e7e\">labrum</span> </strong>and the associated <strong>capsule.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Compression <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> on the <strong>anteromedial</strong> humeral head.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Instability and pain during shoulder movements</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Shoulder <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anterior</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anterior</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior</p>\n<p>(Surgical <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> of this <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> is necessary to prevent osteonecrosis)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/uyk8Y8glK1zlXibijRbb1743074870.mp3", "video": ""}, {"text": "Match the following images with appropriate tests. 1. a) Dugas test 2. b) Callaway test 3. c) Hamilton ruler test 4. d) Regimen batch sign", "options": [{"label": "A", "text": "1-c, 2-d, 3-a, 4-b", "correct": true}, {"label": "B", "text": "1-b, 2-a, 3-d, 4-c", "correct": false}, {"label": "C", "text": "1-d, 2-b, 3-c, 4-a", "correct": false}, {"label": "D", "text": "1-a, 2-c, 3-b, 4-d", "correct": false}], "correct_answer": "A. 1-c, 2-d, 3-a, 4-b", "question_images": ["https://image.prepladder.com/notes/1IlWTNU1chogqAAtuiLm1745585610.png", "https://image.prepladder.com/content/cHpX9BynPC5CupPLq97K1737929590.png", "https://image.prepladder.com/content/b4y5GGEpIgydetOfL4BL1737929634.png", "https://image.prepladder.com/notes/kZHBYplphozlT5c5eMjV1745586251.png"], "explanation_images": ["https://image.prepladder.com/notes/1IlWTNU1chogqAAtuiLm1745585610.png", "https://image.prepladder.com/content/L50HM9lFl3ugDIuQJHeX1737929787.png", "https://image.prepladder.com/notes/kZHBYplphozlT5c5eMjV1745586251.png", "https://image.prepladder.com/content/2KbymacSL3BZyi4FeaAq1737929858.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tests of Shoulder dislocation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hamilton's ruler test</strong><strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measures the distance from the <span class=\"customMeta\" data-dictid=\"7ce5726fb0169277718072972038ca\">acromion</span> to the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"9cdc5a92a216927771870d4b257a80\">epicondyle</span> with the arm in a neutral position. A lack of gap between the arm and the ruler indicates dislocation.</p>\n<p><img alt=\"Callaway test\" data-author=\"\" data-hash=\"11307\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/1IlWTNU1chogqAAtuiLm1745585610.png\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dugas test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The inability to touch the opposite shoulder with a shoulder <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> is typically observed in <strong>anterior dislocations.</strong></p>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"329\" src=\"https://image.prepladder.com/content/L50HM9lFl3ugDIuQJHeX1737929787.png\" width=\"310\"/></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Callaway test </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"0e190b1ed716927771848781259060\">circumference</span> of the <span class=\"customMeta\" data-dictid=\"a6218759db1692777182316d0cd2aa\">axilla</span> is checked bilaterally using a measuring tape. An <strong>increased circumference</strong> on the affected side is <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> of dislocation.</p>\n<img alt=\"Callaway test\" data-author=\"\" data-hash=\"11308\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/kZHBYplphozlT5c5eMjV1745586251.png\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bryants test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It involves observing the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> axillary fold, displaced <strong>inferiorly</strong> on the affected side in shoulder dislocation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Regimen batch sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Loss of sensation over the <span class=\"customMeta\" data-dictid=\"70d60276a81692777185b5f6f71fa9\">deltoid</span> on the affected side due to<strong> axillary nerve damage.</strong></p>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"338\" src=\"https://image.prepladder.com/content/2KbymacSL3BZyi4FeaAq1737929858.png\" width=\"318\"/></p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/gIbFexHiHstCSIg9CO4C1743085992.mp3", "video": ""}, {"text": "A 30-year-old male presents to the emergency department after a seizure. He has severe pain and immobility in his right shoulder, which appears flattened and is held in an adducted and internally rotated position. An X-ray is performed. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Anterior shoulder dislocation", "correct": false}, {"label": "B", "text": "Inferior shoulder dislocation", "correct": false}, {"label": "C", "text": "Acromioclavicular joint dislocation", "correct": false}, {"label": "D", "text": "Posterior shoulder dislocation", "correct": true}], "correct_answer": "D. Posterior shoulder dislocation", "question_images": ["https://image.prepladder.com/content/Pa49wCDS46dCT0KSHwml1737929001.png"], "explanation_images": ["https://image.prepladder.com/content/L966LHg3eUVyYb7WmwYw1737929106.png", "https://image.prepladder.com/content/4rWpJLX2OYeDqL0U1Koc1737929173.png", "https://image.prepladder.com/content/XEFIS98TjVxuOjz5jHlH1737929229.png", "https://image.prepladder.com/content/affviy5jGA5xkYNQpr4U1737929286.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:663px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior dislocation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior dislocation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inferior dislocation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Frequency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Most common</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not very common</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fall on an outstretched hand with an abducted and externally rotated shoulder.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs during <strong>seizures or convulsions</strong>.</p>\n<ul>\n<li>A fall onto a <strong>flexed, adducted arm</strong>.</li>\n<li>A direct impact to the <strong>anterior aspect of the shoulder</strong>.</li>\n<li>A fall onto an <strong>outstretched hand</strong>.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Also called <strong>luxatio erecta.</strong></li>\n<li>Result from a severe hyper-abduction force.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical presentation</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pain, <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> and movement restriction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Duga’s test, Hamilton ruler test and Regimental <span class=\"customMeta\" data-dictid=\"3fb38cd2a416927771822103bd8bcd\">badge</span> test.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Callaway’s test and Regimental <span class=\"customMeta\" data-dictid=\"3fb38cd2a416927771822103bd8bcd\">badge</span> test</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bryant’s test</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arm Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Abduction and external rotation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adduction and internal rotation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arm locked in hyperabduction with the hand positioned above the head.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The humeral head is displaced anteriorly and inferiorly, often under the <span class=\"customMeta\" data-dictid=\"6d706ad0a916927771852098e31258\">coracoid</span> process <strong>(\"subcoracoid\" position).</strong></li>\n<li><strong>\"Hill-Sachs lesion\" </strong>(compression <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> on the <span class=\"customMeta\" data-dictid=\"0b858004a11692777196bac353c12b\">posterolateral</span> aspect of the humeral head).</li>\n</ul>\n<p><img alt=\"\" data-author=\"Hellerhoff, \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Dislocated_shoulder_X-ray_03.png\" data-tags=\"\" height=\"727\" src=\"https://image.prepladder.com/content/L966LHg3eUVyYb7WmwYw1737929106.png\" width=\"500\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The humeral head is displaced posteriorly, appearing closer to the scapula.</li>\n<li><strong>‘Light bulb sign</strong>’(humeral head appears rounded due to internal rotation).</li>\n<li><strong>‘Rim sign’</strong> (widening of the <span class=\"customMeta\" data-dictid=\"138e482a341692777188df645a942c\">glenohumeral</span> joint space).</li>\n<li><strong>‘Reverse Hill-Sachs lesion’</strong> (compression <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> on the <span class=\"customMeta\" data-dictid=\"f90b38d04f16927771818db430bf86\">anteromedial</span> humeral head).</li>\n</ul>\n<p><img alt=\"\" data-author=\"Ganzer fall\" data-hash=\"\" data-license=\"CC BY-NC SA 3.0\" data-source=\"https://pacs.de/term/gluehbirnenzeichen-hintere-schulterluxation\" data-tags=\"\" height=\"426\" src=\"https://image.prepladder.com/content/4rWpJLX2OYeDqL0U1Koc1737929173.png\" width=\"500\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The humeral head is displaced inferiorly below the <span class=\"customMeta\" data-dictid=\"7649bd0f191692777188dcdf91af69\">glenoid</span> cavity.</p>\n<p><img alt=\"\" data-author=\"Hellerhoff, \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Luxatio_erecta_-_74jw_-_Roe_0001.jpg\" data-tags=\"\" height=\"670\" src=\"https://image.prepladder.com/content/XEFIS98TjVxuOjz5jHlH1737929229.png\" width=\"500\"/></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduction techniques:</p>\n<ul>\n<li><strong>Kocher's method </strong>(Most commonly used)</li>\n<li>Hippocrates method</li>\n<li>Stimson’s technique</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduction and immobility, followed by active exercises.</p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Closed reduction</li>\n<li>Open reduction if soft tissue injuries are present</li>\n<li>Re-examination after reduction to avoid <span class=\"customMeta\" data-dictid=\"d100eb4ed81692777193b7f47b5cba\">neurovascular</span> injuries.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Early:</strong>\n<ul>\n<li>Neurovascular injuries</li>\n<li>Rotator <span class=\"customMeta\" data-dictid=\"074fda92471692777185c9d613a2ea\">cuff</span> tear</li>\n</ul>\n</li>\n<li><strong>Delayed:</strong>\n<ul>\n<li>Recurrence</li>\n<li>Stiffness</li>\n<li>Unreduced dislocation</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recurrence</li>\n<li>Unreduced dislocation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Neurovascular injuries</li>\n<li>Recurrence</li>\n<li>Unreduced dislocation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/BWAtZGOjQi5Lhd30WBq31743074114.mp3", "video": ""}, {"text": "A 30-year-old male athlete presents with shoulder pain and instability after a football injury. Examination reveals anterior dislocation of the humeral head. Which of the following provides static stability to the shoulder joint?", "options": [{"label": "A", "text": "b", "correct": false}, {"label": "B", "text": "d", "correct": false}, {"label": "C", "text": "a", "correct": false}, {"label": "D", "text": "c", "correct": true}], "correct_answer": "D. c", "question_images": ["https://image.prepladder.com/content/ECg5yjH1zJiA6mLVkVv61737928706.png"], "explanation_images": ["https://image.prepladder.com/content/Ryw91FAN2u9P8zexlOKg1737928745.png", "https://image.prepladder.com/content/f7mDznzBWHSIj3YlTZKW1737928798.png", "https://image.prepladder.com/content/D3vkExDSEZiqUjHJYZBV1737928848.png", "https://image.prepladder.com/content/TP0szCPTc0lWgm3pW9oc1737928893.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:634px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Static Stabilizers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dynamic Stabilizers</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Glenoid labrum</strong>: Enhances stability by deepening the <span class=\"customMeta\" data-dictid=\"7649bd0f191692777188dcdf91af69\">glenoid</span> cavity.</li>\n<li><strong>Glenohumeral ligaments</strong> <strong>(Superior, Middle, and <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">Inferior</span> Ligaments)</strong> <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> the <span class=\"customMeta\" data-dictid=\"138e482a341692777188df645a942c\">glenohumeral</span> joint<strong> <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> </strong><strong>(c)</strong>, connecting the <span class=\"customMeta\" data-dictid=\"7649bd0f191692777188dcdf91af69\">glenoid</span> <span class=\"customMeta\" data-dictid=\"30a1ba21881692777203de4e7b8537\">fossa</span> to the humerus.</li>\n<li><strong>Coracoclavicular ligament</strong></li>\n<li><strong>Coracohumeral ligament</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Long Head of the <span class=\"customMeta\" data-dictid=\"6b395fd7b21692777183cf78e12920\">Biceps</span> <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">Tendon</span> </strong><strong>(d)</strong>: Provides stability and support.</li>\n<li><strong>Rotator <span class=\"customMeta\" data-dictid=\"074fda92471692777185c9d613a2ea\">Cuff</span> Muscles:</strong>\n<ul>\n<li><strong>Supraspinatus </strong><strong>(a)</strong>: Assists in the <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> and stabilises the head of the humerus.</li>\n<li><strong>Infraspinatus</strong>: External <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> and stabilisation.</li>\n<li><strong>Teres Minor </strong><strong>(b)</strong>: External <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> and stabilisation.</li>\n<li><strong>Subscapularis</strong>: Internal <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> and stabilization.</li>\n</ul>\n</li>\n<li><strong>Deltoid </strong><strong>(Option D):</strong> It facilitates arm movements such as abduction, flexion, and <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> while stabilizing the shoulder joint.</li>\n<li><strong>Periscapular muscles</strong>: Stabilize the <span class=\"customMeta\" data-dictid=\"153f2ea4be16927771981ce5d9171f\">scapula</span> &amp; <span class=\"customMeta\" data-dictid=\"f0cdc42a0c1692777198f54a380826\">shoulder joint</span> during movement.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/D3vkExDSEZiqUjHJYZBV1737928848.png\" width=\"500\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/TP0szCPTc0lWgm3pW9oc1737928893.png\" width=\"500\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/OYPda02YPjoj7G8xXvfH1742994408.mp3", "video": ""}, {"text": "A one-year-old child is brought to the emergency department after a fall, and the caregiver reports mild pain over the right shoulder while the child remains active. An X-ray is provided. What is the most appropriate treatment option for managing this condition?", "options": [{"label": "A", "text": "Figure-of-8 Bandage", "correct": false}, {"label": "B", "text": "Cuff and Collar Sling", "correct": true}, {"label": "C", "text": "Billington Yoke method", "correct": false}, {"label": "D", "text": "Intramedullary Nail Fixation", "correct": false}], "correct_answer": "B. Cuff and Collar Sling", "question_images": ["https://image.prepladder.com/content/Cb9Hw0QTIeybD5S0U8wR1737928366.png"], "explanation_images": ["https://image.prepladder.com/content/zNFehthIiTco59OArTO51737928438.png", "https://image.prepladder.com/content/u8yAVIcTeORIFD3dB2JR1737928481.png", "https://image.prepladder.com/content/BLtQk31FrXVcYAPnTutJ1737928515.png", "https://image.prepladder.com/content/UnXkOykmdXS0KheR3PcF1737928574.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:643px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management Approach</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Newborn to Pre-Ambulatory Children</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Symptomatic treatment with the arm <span class=\"customMeta\" data-dictid=\"d82fcb9d1f16927771836a9f6ccf14\">bound</span> to the chest or a <strong>cuff and collar sling. </strong></li>\n<li><strong>Figure-of-8 bandages</strong> are not used for children<strong> under two years.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ambulatory Children (2–12 years)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Use figure-of-8 bandages, tightened after three days and again after one week.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age &gt;12 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Commercially available figure-of-8 harnesses are recommended.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/u1mKtJjn7ei2WiIvuE191742994004.mp3", "video": ""}, {"text": "A 23-year-old male presents after a fall onto his shoulder. He complains of pain and difficulty moving the affected arm. Based on the clinical presentation and x-ray findings shown in the image, which of the following statements is true regarding the condition and its complications? Injury to the lateral cord of the brachial plexus is more common than medial cord Malunion is the most common complication Subclavian vessels are at more risk of injury Shoulder stiffness occurs as a late complication", "options": [{"label": "A", "text": "All statements are true", "correct": false}, {"label": "B", "text": "Only statements 1 and 2 are true", "correct": false}, {"label": "C", "text": "Only statements 2 and 4 are true", "correct": false}, {"label": "D", "text": "Statements 2,3 and 4 are true", "correct": true}], "correct_answer": "D. Statements 2,3 and 4 are true", "question_images": ["https://image.prepladder.com/content/Nz36voDHOJ7A9jgqT6iW1737928046.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fsP2hhgrPnce01WsDTHT1742993862.mp3", "video": ""}, {"text": "A 30-year-old patient arrives at the emergency department after falling onto the shoulder &amp;amp; reports severe pain and tenderness in the shoulder, with noticeable swelling. X-ray findings are given in the image below. What is the most common site associated with this condition?", "options": [{"label": "A", "text": "Medial 1/3rd &amp;amp; lateral 2/3rd junction", "correct": false}, {"label": "B", "text": "Proximal 1/3rd &amp;amp; distal 2/3rd junction", "correct": false}, {"label": "C", "text": "Medial 2/3rd &amp;amp; lateral 1/3rd junction", "correct": true}, {"label": "D", "text": "Midshaft &amp;amp; lateral 1/3rd junction", "correct": false}], "correct_answer": "C. Medial 2/3rd &amp; lateral 1/3rd junction", "question_images": ["https://image.prepladder.com/content/0ox4i6MfC1QxOX3yejhU1737928165.png"], "explanation_images": ["https://image.prepladder.com/content/qJ7N0hzMBOWsnwZgy39m1737927494.png", "https://image.prepladder.com/content/5IJbuXs5bbhtKgeBj1KM1737927591.png", "https://image.prepladder.com/content/8IIoyZfM8NI268dCH1HB1737927795.png", "https://image.prepladder.com/content/d0r255SY46IkI9mM4Llg1737927724.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/eEsCSw1Mz8DJYNqbSD6r1742993659.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 37 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 15</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition w-full md:w-auto" disabled="" id="previous-btn">Previous</button> <button class="bg-yellow-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-yellow-400 transition w-full md:w-auto" id="mark-review">Mark for Review</button> <button class="bg-blue-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="next-btn">Next</button> <button class="bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full md:w-auto" id="nav-toggle">Questions Navigation</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-blue-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto p-4 md:p-6 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Upper Limb Traumatology-Upper Limb Trauma-Ii Congenital Torticollis - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 15</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn" id="results-nav-toggle">Results Navigation</button> <button aria-label="Next question result" class="result-nav-btn" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-blue-500 text-white px-6 py-2 rounded-lg hover:bg-blue-600 transition" id="take-again">Take Again</button> <button class="bg-gray-500 text-white px-6 py-2 rounded-lg hover:bg-gray-600 transition" id="review-test">Review Test</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 15 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 3-year-old child is brought to the emergency department after a sudden pull on their arm. The child is holding their right arm close to their body and refuses to move it. There is tenderness over the radial head but no swelling or deformity. What is the most likely arm position in this condition?", "options": [{"label": "A", "text": "Extended and pronated", "correct": false}, {"label": "B", "text": "Flexed and pronated", "correct": true}, {"label": "C", "text": "Extended and supinated", "correct": false}, {"label": "D", "text": "Flexed and supinated", "correct": false}], "correct_answer": "B. Flexed and pronated", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/eAZUAja4wtbVQB4TQUCd1737770146.png", "https://image.prepladder.com/content/8GpCD1tU7V0XzZqunXHM1737770203.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:735px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulled Elbow (also known as Nursemaid’s Elbow)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age group </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1-5 years (most common)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A sudden <span class=\"customMeta\" data-dictid=\"b88c1802e21692777190700ee5b998\">jerk</span> or pull on the arm when it is <strong>extended and pronated</strong> causes the <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head to slip out of the <span class=\"customMeta\" data-dictid=\"96f5104d6816927771816ac8dfceeb\">annular</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (radial head subluxation).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical presentation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The child holds the affected arm close to the body in a <strong>slightly flexed and pronated</strong> position, resisting movement, particularly supination.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diagnosis is usually clinical.</li>\n<li>X-ray is unnecessary unless there is suspicion of other injuries.\n\t\t\t\t<ul>\n<li>It may appear normal</li>\n<li>If visible, they can show subtle <strong>displacement of the <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head</strong>, with the possible <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> of the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> fat pad or visibility of the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> fat pad, indicating joint effusion.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduction of the <span class=\"customMeta\" data-dictid=\"e53b153fb316927771996481a3e88f\">subluxation</span> by <strong>supination and flexion</strong> or <strong>hyperpronation</strong> of the <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> typically results in immediate relief.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/4Rk8yRfB2rY4xCfQwUTA1743162072.mp3", "video": ""}, {"text": "Match the following epiphyseal centres with their respective ages based on their appearance. 1. Capitulum a. 4 years 2. Radial head b. 8 years 3. Medial epicondyle c. 2 years 4. Trochlea appears d. 6 years", "options": [{"label": "A", "text": "1-c, 2-d, 3-a, 4-b", "correct": false}, {"label": "B", "text": "1-d, 2-a, 3-b, 4-c", "correct": false}, {"label": "C", "text": "1-b, 2-c, 3-a, 4-d", "correct": false}, {"label": "D", "text": "1-c, 2-a, 3-d, 4-b", "correct": true}], "correct_answer": "D. 1-c, 2-a, 3-d, 4-b", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/N521TBd8YEmbWVd4ECHU1737770310.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:469px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epiphyseal centers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age of Appearance </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Capitulum </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radial head </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medial <span class=\"customMeta\" data-dictid=\"9cdc5a92a216927771870d4b257a80\">epicondyle</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Trochlea </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Olecranon </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lateral <span class=\"customMeta\" data-dictid=\"9cdc5a92a216927771870d4b257a80\">epicondyle</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12 years</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/BxlNw3RLsKMjkLagPIXB1745059398.mp3", "video": ""}, {"text": "A 35-year-old male fell from a height of about 6 feet while carrying a heavy load, landing on his left side and bracing himself with his left arm. Upon examination, there is a visible deformity in the mid-forearm region, and the elbow is swollen. Given the X-ray findings, what is the most probable diagnosis?", "options": [{"label": "A", "text": "Monteggia fracture", "correct": true}, {"label": "B", "text": "Galeazzi fracture", "correct": false}, {"label": "C", "text": "Essex Lopresti fracture", "correct": false}, {"label": "D", "text": "Nightstick fracture", "correct": false}], "correct_answer": "A. Monteggia fracture", "question_images": ["https://image.prepladder.com/content/pPCQHA9UrdMg1ppIFO1D1737770433.png"], "explanation_images": ["https://image.prepladder.com/content/3SSwKZivpzTBRePVXI0Q1737770499.png", "https://image.prepladder.com/content/EwWx0T8yt0nsA8eYBB7K1737770557.png", "https://image.prepladder.com/content/4RBSl9CpJ8DtjAcoCZ8J1737770643.png", "https://image.prepladder.com/content/5RzSBUiUKdMwEc0idtO71737770703.png", "https://image.prepladder.com/content/KWaBpn9FX64KwpuQzXg31737770793.png", "https://image.prepladder.com/content/C8U12BshuOC0lMeaRAs01737770859.png", "https://image.prepladder.com/content/0Io6uRI12spnalINmjiW1737770937.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:622px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Monteggia fracture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Site </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fracture of the <strong>proximal third of the ulna</strong> is accompanied by a <strong>radial head dislocation</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fall on an outstretched hand</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"283\" src=\"https://image.prepladder.com/content/3SSwKZivpzTBRePVXI0Q1737770499.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Nerve injury (Posterior <span class=\"customMeta\" data-dictid=\"72b8cffc701692777190c03a6968ab\">Interosseous</span> Nerve)</strong></li>\n<li>Malunion</li>\n<li>Non-union</li>\n<li>Cubitus valgus.</li>\n<li>Radio <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> <span class=\"customMeta\" data-dictid=\"6aec71db0e169277719908863ce421\">synostosis</span> (Type 4 Monteggia Fracture)</li>\n<li>Myositis Ossificans.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/paoKZwQWAUgNMdEKI4KJ1743162612.mp3", "video": ""}, {"text": "A 22-year-old playing rugby fell awkwardly after being tackled, landing on his outstretched left arm, and experienced immediate pain in his forearm and elbow. He arrives at the emergency department with intense pain and is unable to flex or extend his elbow. Based on the X-ray findings, which type of Bado's classification does this injury represent?", "options": [{"label": "A", "text": "Type I", "correct": false}, {"label": "B", "text": "Type II", "correct": true}, {"label": "C", "text": "Type III", "correct": false}, {"label": "D", "text": "Type IV", "correct": false}], "correct_answer": "B. Type II", "question_images": ["https://image.prepladder.com/content/okZqGtTrQ770c70v71NW1737771060.png"], "explanation_images": ["https://image.prepladder.com/content/BdnlrXljOeH0271RQSGY1737771172.png", "https://image.prepladder.com/content/RWoNJ3sNbYfkGEGeBLgF1737771255.png", "https://image.prepladder.com/content/0a4hLURex05pBSWIKAky1737771357.png", "https://image.prepladder.com/content/0Uw9nqTRSwJjZ7b8pe2v1737771400.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:626px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bado’s Classification</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Seen in </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Image </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type I</strong></p>\n<p><strong>(Extension Type)</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>Anterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of the <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head with <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> angulation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Children (more common)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/BdnlrXljOeH0271RQSGY1737771172.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type II</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>Posterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of the <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head with <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> angulation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adults (more common)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/RWoNJ3sNbYfkGEGeBLgF1737771255.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type III</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of the <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Exclusively in children</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/0a4hLURex05pBSWIKAky1737771357.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type IV</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of the <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head and fractures of both the <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> and <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> occur at the same <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> level.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Exclusively in adults</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/0Uw9nqTRSwJjZ7b8pe2v1737771400.png\" width=\"500\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ArqMKtD9mj5ACEv2JfhD1743162964.mp3", "video": ""}, {"text": "A 30-year-old female slipped while demonstrating an exercise in a fitness class, landing on her outstretched right arm. She arrives at the emergency department with severe pain in her right wrist and forearm. Upon examination, her wrist appears unstable. Based on the X-ray findings, which of the following statements is true regarding her condition?", "options": [{"label": "A", "text": "Fracture of necessity", "correct": true}, {"label": "B", "text": "Galeazzi sign can be elicited", "correct": false}, {"label": "C", "text": "Less common than Monteggia fracture", "correct": false}, {"label": "D", "text": "Posterior interosseous nerve is commonly involved", "correct": false}], "correct_answer": "A. Fracture of necessity", "question_images": ["https://image.prepladder.com/content/MqCtMYvZWM3oiMIT1iVb1737771859.png"], "explanation_images": ["https://image.prepladder.com/content/VF4qgdfdtRtCpMFE7I7B1737772022.png", "https://image.prepladder.com/content/fn4kOipZCH1hUtLLnyDt1737771965.png", "https://image.prepladder.com/content/uiJn4EkjixmRLNVDMwOe1737772076.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:684px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Galeazzi fracture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is more common in adults.</li>\n<li>Three times more common than Monteggia <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fall on an outstretched hand (marked <span class=\"customMeta\" data-dictid=\"189ee8a22a1692777196b04278555f\">pronation</span> of the forearm).</li>\n<li>Direct blow on the <span class=\"customMeta\" data-dictid=\"4c94b3faab16927771861e13308510\">dorsolateral</span> side of the forearm</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Prominence and <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> at the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> end of the <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> (main feature).</strong></li>\n<li><strong>Piano key sign: </strong>It is a <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> where the <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> <span class=\"customMeta\" data-dictid=\"29e4241b931692777199403b75a8e3\">styloid</span> moves up and down when pressure is applied, resembling a piano key. This movement indicates <span class=\"customMeta\" data-dictid=\"e53b153fb316927771996481a3e88f\">subluxation</span> or <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of the joint.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reveals a <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of the <strong>distal third of the <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> </strong>and a <strong>dislocation of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"6c5e87b03d1692777197e1150ae78a\">radioulnar</span> joint</strong>.</p>\n<p><img alt=\"\" data-author=\"Zimmermann\" data-hash=\"\" data-license=\" CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Galeazzi_fracture#/media/File:Galeazzifraktur_1_THWZ.jpg\" data-tags=\"\" height=\"752\" src=\"https://image.prepladder.com/content/VF4qgdfdtRtCpMFE7I7B1737772022.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgery is necessary (fracture of necessity) <strong>(Option A)</strong>:<strong> </strong><strong>ORIF with long plate and screw (treatment of choice).</strong></p>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/fn4kOipZCH1hUtLLnyDt1737771965.png\" width=\"500\"/></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nerve injury\n\t\t\t\t<ul>\n<li><strong>Ulnar nerve injury.</strong></li>\n<li><strong>Anterior <span class=\"customMeta\" data-dictid=\"72b8cffc701692777190c03a6968ab\">Interosseous</span> nerve injury </strong><strong>(Option D)</strong></li>\n</ul>\n</li>\n<li>Entrapment of <span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\">Extensor</span> carpi <span class=\"customMeta\" data-dictid=\"d4cb28e3e91692777201b2085b4f79\">ulnaris</span> <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> (rare).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/cTxCQfntyMCINJnj5k8f1743228604.mp3", "video": ""}, {"text": "Match the following images with their respective fractures: 1. Colles fracture a) 2. Smith fracture b) 3. Barton’s fracture c) 4. Chauffeur fracture d)", "options": [{"label": "A", "text": "1-b, 2-a, 3-c, 4-d", "correct": false}, {"label": "B", "text": "1-d, 2-c, 3-a, 4-b", "correct": false}, {"label": "C", "text": "1-c, 2-d, 3-b, 4-a", "correct": false}, {"label": "D", "text": "1-c, 2-a, 3-d, 4-b", "correct": true}], "correct_answer": "D. 1-c, 2-a, 3-d, 4-b", "question_images": ["https://image.prepladder.com/notes/1x2x2EiOGKmakDDTgNwz1745066135.png", "https://image.prepladder.com/notes/SD0K5Sf6a5hscQVU6tFQ1745066394.png", "https://image.prepladder.com/notes/f79dvXBch09qFyomxthI1745066535.png", "https://image.prepladder.com/notes/s8BLBmsgwrIfEm9lnTzb1745066651.png"], "explanation_images": ["https://image.prepladder.com/content/WRjsZY63qVSt5HKmTO0H1737772859.png", "https://image.prepladder.com/notes/f79dvXBch09qFyomxthI1745066535.png", "https://image.prepladder.com/content/2lv60YPmfXv94pygbVIe1737772998.png", "https://image.prepladder.com/notes/1x2x2EiOGKmakDDTgNwz1745066135.png", "https://image.prepladder.com/notes/s8BLBmsgwrIfEm9lnTzb1745066651.png", "https://image.prepladder.com/notes/SD0K5Sf6a5hscQVU6tFQ1745066394.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Colles <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> (Poutteau's fracture)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Located near the cortico-cancellous <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> (about 2 cm from the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> surface) with<strong> </strong><strong>dorsal <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> fragment</strong></li>\n<li>Fall on an outstretched hand in a pronated and dorsiflexed position.</li>\n<li>‘<strong>Dinner-fork’ deformity: </strong>Prominence on the back of the wrist and depression in front.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"CC BY 1.0\" data-source=\"https://www.physio-pedia.com/File:Colles-fracture.jpg\" data-tags=\"\" height=\"1974\" src=\"https://image.prepladder.com/content/WRjsZY63qVSt5HKmTO0H1737772859.png\" width=\"4000\"/></p>\n<p style=\"text-align:center\"><img alt=\"Option C - Colles\" data-author=\"\" data-hash=\"10464\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/f79dvXBch09qFyomxthI1745066535.png\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><strong>Smiths’ <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> (Reverse Colles’)</strong></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Distal fragment shifts and tilts <strong>ventrally</strong>.</li>\n<li>Fall on outstretched hand in a pronated and flexed hand.</li>\n<li><strong>Garden spade deformity: Prominent <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> bulge and a flexed wrist position.</strong></li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"3996\" src=\"https://image.prepladder.com/content/2lv60YPmfXv94pygbVIe1737772998.png\" width=\"4000\"/></p>\n<p style=\"text-align:center\"><img alt=\"Option A Smiths xray\" data-author=\"\" data-hash=\"10461\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/1x2x2EiOGKmakDDTgNwz1745066135.png\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Barton’s Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Intra-articular <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> radius,</strong> specifically involving the<strong> <span class=\"customMeta\" data-dictid=\"8e0bd6da651692777202f38aeec153\">volar</span> half</strong> that shears off and moves forward, carrying the <span class=\"customMeta\" data-dictid=\"5b1b826a0616927771836ab5f0595c\">carpus</span> along with it.</li>\n<li>This injury typically occurs due to falling on an outstretched hand (FOOSH injury) and is often associated with<strong> wrist instability</strong> and<strong> <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> involvement.</strong></li>\n</ul>\n<p><br/>\n<img alt=\"Option D Bartons fraccture\" data-author=\"\" data-hash=\"10465\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/s8BLBmsgwrIfEm9lnTzb1745066651.png\" style=\"float:left\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chauffeur’s <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> (Radial <span class=\"customMeta\" data-dictid=\"29e4241b931692777199403b75a8e3\">Styloid</span> Fracture, Hutchinson's Fracture, Backfire</strong></p>\n<p><strong>Fracture)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fracture of the <strong>radial <span class=\"customMeta\" data-dictid=\"29e4241b931692777199403b75a8e3\">styloid</span> process</strong> of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> radius.</li>\n<li>It is caused by forced <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> of the wrist and may occur after a fall or when a starting handle ‘kicks back’.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"Option B Chauffers\" data-author=\"\" data-hash=\"10462\" data-license=\"\" data-source=\"\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/SD0K5Sf6a5hscQVU6tFQ1745066394.png\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/frtRRNzJlnduPU2VVZMO1745729135.mp3", "video": ""}, {"text": "A 45-year-old male presents to the emergency department after falling while carrying a heavy load. Upon examination, he exhibits swelling, tenderness over the distal radius, and limited wrist motion. An X-ray is shown below. Which of the following statements about this condition is not true?", "options": [{"label": "A", "text": "Fall on an outstretched hand with the wrist flexed", "correct": false}, {"label": "B", "text": "Presents with a \"garden spade\" appearance", "correct": false}, {"label": "C", "text": "Managed with a \"handshake\" cast", "correct": true}, {"label": "D", "text": "Involves volar displacement of the distal radius", "correct": false}], "correct_answer": "C. Managed with a \"handshake\" cast", "question_images": ["https://image.prepladder.com/content/DwHHnA82CwTbb2u1J4HK1737773482.png"], "explanation_images": ["https://image.prepladder.com/content/7Mbb2NJBbhbSqQdHu4mH1737773541.png", "https://image.prepladder.com/content/SVa2ABPNA0CAJCc82bso1737773583.png", "https://image.prepladder.com/content/AVaWK6SrHAfyAd3ONYlq1737773698.png", "https://image.prepladder.com/content/qyELiLhtQf4udbPkscBU1737773747.png", "https://image.prepladder.com/content/2so6QTw5YeoYFhwbIbl41737773788.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:667px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Smith <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> or Reverse Colles fracture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Site </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> end of the <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> with <span class=\"customMeta\" data-dictid=\"8e0bd6da651692777202f38aeec153\">volar</span> <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> fragment (opposite to a Colles fracture).<strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It occurs due to a <strong>fall on an outstretched hand with a flexed wrist</strong>, leading to <span class=\"customMeta\" data-dictid=\"9ccb2fd2f31692777201e231bfda74\">ventral</span> <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> and tilting of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> fragment. <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Shows a <strong>tilted or displaced <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> fragment</strong> at the radius.</p>\n<p><img alt=\"\" data-author=\"JAMES HEILMAN\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Smith%27s_fracture#/media/File:Smith2019Frac.jpg\" data-tags=\"\" height=\"437\" src=\"https://image.prepladder.com/content/SVa2ABPNA0CAJCc82bso1737773583.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Closed reduction</strong> followed by above-elbow <span class=\"customMeta\" data-dictid=\"6c22f2390016927771955c0c04b851\">plaster</span> of Paris (POP) immobilisation in extension for six weeks.</li>\n<li><strong>Open reduction</strong> using an<strong> Ellis plate</strong> (if <span class=\"customMeta\" data-dictid=\"da014870171692777184980beab405\">closed reduction</span> is unsuccessful).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Garden Spade Deformity</strong>: Characterized by a prominent <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> bulge and a flexed wrist position. <strong>(Option B)</strong></p>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"499\" src=\"https://image.prepladder.com/content/AVaWK6SrHAfyAd3ONYlq1737773698.png\" width=\"500\"/><br/>\n\t\t\t </td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:755px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of Cast</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Position/Purpose</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Colles' Cast (Handshake Cast)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Colles' <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> (distal radius)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Palmar flexion,pronation and <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> (prevent <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> displacement).</p>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/qyELiLhtQf4udbPkscBU1737773747.png\" width=\"500\"/></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Scaphoid Cast (Glass Holding Cast)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Scaphoid fracture</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Wrist in slight extension, <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> with thumb in opposition.</p>\n<p><img alt=\"\" data-author=\"Frankie Fouganthin\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Cast_wrist_after_fracture_of_the_scaphoid_bone.jpg\" data-tags=\"\" height=\"265\" src=\"https://image.prepladder.com/content/2so6QTw5YeoYFhwbIbl41737773788.png\" width=\"500\"/></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ulnar <span class=\"customMeta\" data-dictid=\"9c851eff8a1692777188d638767d86\">Gutter</span> Cast</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fractures of 4th and 5th metacarpals</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immobilises the wrist and fingers in a neutral/slightly flexed position.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radial <span class=\"customMeta\" data-dictid=\"9c851eff8a1692777188d638767d86\">Gutter</span> Cast</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fractures of 2nd and 3rd metacarpals</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immobilises wrist and fingers in a functional position.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sarmiento Cast</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mid-shaft <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> fractures</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Allows elbow movement while immobilising the <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> for functional healing.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patellar <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">Tendon</span> <span class=\"customMeta\" data-dictid=\"2bb6ddacfd169277718230a816b21f\">Bearing</span> (PTB) Cast</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tibial fractures</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Allows partial weight-bearing without stressing the <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> site.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hip <span class=\"customMeta\" data-dictid=\"f2ad4340681692777199d8bf0f5cbb\">Spica</span> Cast</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Femoral fractures in children</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immobilises hip and leg for <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> and <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> stabilisation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/UfBLGpp3Otwbd241VxTK1743229563.mp3", "video": ""}, {"text": "A 25-year-old male presents to the emergency department after falling on an outstretched hand during a sports activity. He complains of pain and swelling in his wrist, with tenderness in the anatomical snuffbox. X-ray imaging reveals a fracture of a carpal bone. What is the most common site of this fracture, and which part is most at risk for avascular necrosis?", "options": [{"label": "A", "text": "Proximal pole, Distal pole", "correct": false}, {"label": "B", "text": "Proximal pole, Waist", "correct": false}, {"label": "C", "text": "Waist, Distal pole", "correct": false}, {"label": "D", "text": "Waist, Proximal pole", "correct": true}], "correct_answer": "D. Waist, Proximal pole", "question_images": ["https://image.prepladder.com/content/C3BIhjF7pyVzSg2xR1CM1737773915.png"], "explanation_images": ["https://image.prepladder.com/content/MSTTdhlg9BuZ7y3BZF4k1737773974.png", "https://image.prepladder.com/content/xi6bks3dDn6Opn9kuTUH1737774029.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:666px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Scaphoid fracture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Site </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Waist of <span class=\"customMeta\" data-dictid=\"4992469b3c169277719874a6808793\">scaphoid</span> (most common) (Option D)</strong></li>\n<li>Distal pole (Least common)</li>\n<li>Proximal pole (high risk for <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> necrosis)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically caused by a <strong>fall on an outstretched hand (FOOSH)</strong> with the wrist in dorsiflexion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>It is more common in young adults</strong>, particularly athletes.</li>\n<li>Pain and <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> localised to the <strong>anatomical snuffbox</strong> (the depression between the tendons of the <span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\">extensor</span> pollicis <span class=\"customMeta\" data-dictid=\"7ff574b4f61692777191fa536b5e6c\">longus</span> and the <span class=\"customMeta\" data-dictid=\"1a19c0413216927771801f371db10e\">abductor</span> pollicis longus/extensor pollicis brevis).</li>\n<li>Swelling and <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"069cba94231692777197b41e753795\">range of motion</span> at the wrist.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>There is a visible <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> line at the waist of the scaphoid, with possible <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> or displacement; <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> may later appear as <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> in the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> pole.</p>\n<p><img alt=\"\" data-author=\"GILO1969\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:X-ray_of_scaphoid_fracture.png\" data-tags=\"\" height=\"763\" src=\"https://image.prepladder.com/content/MSTTdhlg9BuZ7y3BZF4k1737773974.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immobilisation by <span class=\"customMeta\" data-dictid=\"4992469b3c169277719874a6808793\">scaphoid</span> cast (3-4 months)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"436\" src=\"https://image.prepladder.com/content/xi6bks3dDn6Opn9kuTUH1737774029.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Avascular <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> (more common in the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> pole)</strong> <strong>(Option D)</strong></li>\n<li><strong>Humpback <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> (displaced <span class=\"customMeta\" data-dictid=\"4992469b3c169277719874a6808793\">Scaphoid</span> fracture)</strong></li>\n<li>Delayed and non-union</li>\n<li>Wrist osteoarthritis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/dKlLzaQvc73N7lJ7KZZl1743230162.mp3", "video": ""}, {"text": "Match the following fractures with their site : 1. Mallet finger a) Comminuted fracture of base of the 1st metacarpal 2. Jersey's finger b) Neck of the 5th metacarpal 3. Rolando fracture c) Oblique fracture of base of the 1st metacarpal 4. Bennett fracture d) Rupture of the extensor tendon at the base of the distal phalanx 5. Boxer's fracture e) Rupture of distal end of flexor digitorum profundus of index finger", "options": [{"label": "A", "text": "1-d, 2-c, 3-b, 4-a, 5-e,", "correct": false}, {"label": "B", "text": "1-d, 2-e, 3-a, 4-c, 5-b", "correct": true}, {"label": "C", "text": "1-b, 2-a, 3-d, 4-e, 5-c,", "correct": false}, {"label": "D", "text": "1-c, 2-e, 3-a, 4-b, 5-d,", "correct": false}], "correct_answer": "B. 1-d, 2-e, 3-a, 4-c, 5-b", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cZLo2fpUkF3uVVVOVVpe1737774334.png", "https://image.prepladder.com/content/CkrLdc85zCEdNCDfXl5b1737774431.png", "https://image.prepladder.com/content/npVsWieJujLmYyVehKID1737774508.png", "https://image.prepladder.com/content/dPfg1nM6hP8qOA3PboMF1737774559.png", "https://image.prepladder.com/content/04efYEWiE6wdn526pcbV1737774623.png", "https://image.prepladder.com/content/3ttzrSv7iwniC61nIdtr1737774678.png", "https://image.prepladder.com/content/tEtcw3BobTEBvMRnhX0x1737774733.png", "https://image.prepladder.com/content/7lqtr4qSDrFdah3TDN901737774793.png", "https://image.prepladder.com/content/3uyItlb2QGq5TsfwoJZE1737774853.png", "https://image.prepladder.com/content/IduexaKTMjNqetJsFs6S1737774904.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:771px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fracture </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Image</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><strong>Mallet finger (Baseball finger)</strong></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A sudden <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> of the <strong>distal <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joint (DIP)</strong> causes the <span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\">extensor</span> <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> at the base of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"e9451cd23d1692777195fe471f486e\">phalanx</span> to be avulsed from its insertion.</li>\n<li><strong>Treatment: </strong>Immobilize the <span class=\"customMeta\" data-dictid=\"fed387a73a16927771862b51ee0f29\">DIP joint</span> (Aluminium <span class=\"customMeta\" data-dictid=\"7f606f911b1692777199eb69ab67c5\">splint</span> or <span class=\"customMeta\" data-dictid=\"6c22f2390016927771955c0c04b851\">plaster</span> cast).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img alt=\"\" data-author=\"HOLLY CHENG\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://pt.m.wikipedia.org/wiki/Ficheiro:Mallet_finger.jpg\" data-tags=\"\" height=\"293\" src=\"https://image.prepladder.com/content/cZLo2fpUkF3uVVVOVVpe1737774334.png\" width=\"500\"/></p>\n<p><img alt=\"\" data-author=\"DAVPLAST\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Mallet_finger_mechanism.png\" data-tags=\"\" height=\"345\" src=\"https://image.prepladder.com/content/CkrLdc85zCEdNCDfXl5b1737774431.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><strong>Jersey's finger</strong></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is caused by sudden <span class=\"customMeta\" data-dictid=\"2ad2fb4cc8169277718925a677620c\">hyperextension</span> of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> joint, leading to <span class=\"customMeta\" data-dictid=\"954dd74f031692777182664659765f\">avulsion</span> of the <strong>flexor digitorum <span class=\"customMeta\" data-dictid=\"69427990841692777196166d7a5ec9\">profundus</span> tendon</strong>. This injury may result in either a <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> of the <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> or the <span class=\"customMeta\" data-dictid=\"2b005085881692777186cf95c3ad51\">detachment</span> of a small bone fragment.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/npVsWieJujLmYyVehKID1737774508.png\" width=\"500\"/></p>\n<p><img alt=\"\" data-author=\"Ho A, Knipe H, Abdeldjalil B\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/jersey-finger\" data-tags=\"\" height=\"239\" src=\"https://image.prepladder.com/content/dPfg1nM6hP8qOA3PboMF1737774559.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rolando fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"9c8512bb5d169277718470669bd36e\">comminuted</span> (3 parts) <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> <strong>(‘T' or 'Y' shaped)</strong> of the base of the <strong>first metacarpal.</strong></li>\n<li><strong>Treatment: </strong>Reduction and <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> with K-wires, followed by immobilisation in a thumb <span class=\"customMeta\" data-dictid=\"f2ad4340681692777199d8bf0f5cbb\">spica</span> for 3 weeks.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img alt=\"\" data-author=\"A.Prof Frank Gaillard\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://www.wikidoc.org/index.php/File:Rolando-fracture.jpg\" data-tags=\"\" height=\"338\" src=\"https://image.prepladder.com/content/04efYEWiE6wdn526pcbV1737774623.png\" width=\"500\"/></p>\n<p><img alt=\"\" data-author=\"Sunyarn Niempoog, T. Waitayawinyu\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.semanticscholar.org/paper/Comminuted-Rolando's-fractures%3A-treatment-with-and-Niempoog-Waitayawinyu/9ac7c24ac6ad6169f294adacab6eef0fd70e89ca\" data-tags=\"\" height=\"301\" src=\"https://image.prepladder.com/content/3ttzrSv7iwniC61nIdtr1737774678.png\" width=\"500\"/></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bennett fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Oblique <span class=\"customMeta\" data-dictid=\"f953c828ea16927771909cb3a51e36\">intra-articular</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> (2 part) of the<strong> base of the first <span class=\"customMeta\" data-dictid=\"3582e886271692777192ab233546a6\">metacarpal</span> with <span class=\"customMeta\" data-dictid=\"e53b153fb316927771996481a3e88f\">subluxation</span> of the metacarpal.</strong></li>\n<li>It is caused by a <span class=\"customMeta\" data-dictid=\"7ba18aa5e616927771918a45051a40\">longitudinal</span> force applied to the thumb.</li>\n<li><strong>Treatment: </strong>\n<ul>\n<li>Closed reduction and <span class=\"customMeta\" data-dictid=\"b2fb1a3a5416927771953ea4fa15e1\">percutaneous</span> K-wire fixation</li>\n<li>Open reduction and internal fixation</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p><img alt=\"\" data-author=\"JAMES HEILMAN\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Bennett%27s_fracture#/media/File:BennettFracMark.png\" data-tags=\"\" height=\"812\" src=\"https://image.prepladder.com/content/tEtcw3BobTEBvMRnhX0x1737774733.png\" width=\"500\"/></p>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"https://sportshanddoctor.com/malunited-bennetts-fracture/\" data-tags=\"\" height=\"314\" src=\"https://image.prepladder.com/content/7lqtr4qSDrFdah3TDN901737774793.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Boxer's fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fracture through the <strong>neck of the <span class=\"customMeta\" data-dictid=\"3582e886271692777192ab233546a6\">metacarpal</span> (commonly the 5th metacarpal). </strong></li>\n<li>Cause: Closed fist hits against a hard object</li>\n<li>Treatment: Mostly conservative</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img alt=\"\" data-author=\"JAMES HEILMAN\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Boxer%27s_fracture#/media/File:Fractured5thMetacarpalHead2018.jpg\" data-tags=\"\" height=\"762\" src=\"https://image.prepladder.com/content/3uyItlb2QGq5TsfwoJZE1737774853.png\" width=\"500\"/></p>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"https://mdwestone.com/boxers-fracture/\" data-tags=\"\" height=\"308\" src=\"https://image.prepladder.com/content/IduexaKTMjNqetJsFs6S1737774904.png\" width=\"500\"/></p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Nj4w5pk5kQ2nAavX9I9M1743230502.mp3", "video": ""}, {"text": "A 28-year-old male presents with severe wrist pain after falling while playing tennis. Upon examination, there is swelling and tenderness on the ulnar side of the wrist, along with difficulty gripping. An X-ray is taken. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Scaphoid fracture", "correct": false}, {"label": "B", "text": "Lunate dislocation", "correct": false}, {"label": "C", "text": "Hook of hamate fracture", "correct": true}, {"label": "D", "text": "Pisiform fracture", "correct": false}], "correct_answer": "C. Hook of hamate fracture", "question_images": ["https://image.prepladder.com/content/22dtqaNKqQlznGNyrGn81737776151.png"], "explanation_images": ["https://image.prepladder.com/content/QheGsopnoLVDs026wwbs1737776243.png", "https://image.prepladder.com/content/mFmP4Le4VpntqF8RG35R1737776305.png", "https://image.prepladder.com/content/K0ejmyBByYccjH1Plqkx1737776371.png", "https://image.prepladder.com/content/tCV9EdVH6KCSkTyHZ5zd1737776460.png", "https://image.prepladder.com/content/0mCiUXHPkk0UFl4pUBo41737776516.png", "https://image.prepladder.com/content/UuEAxUcJAb7K00Bh8zO81737776601.png", "https://image.prepladder.com/content/6SDrb8bKYw7tWtw0MhyE1737776721.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fracture of the Hamate</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Site </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hook of the Hamate</strong> (most common site for fractures)</li>\n<li><strong>Body of the Hamate</strong> (less common, rare)</li>\n</ul>\n<p><img alt=\"\" data-author=\"BODYPARTS 3D\" data-hash=\"\" data-license=\"CC BY SA 2\" data-source=\"https://en.wikipedia.org/wiki/Hamate_bone#/media/File:Hamate_bone_(left_hand)_01_palmar_view.png\" data-tags=\"\" height=\"892\" src=\"https://image.prepladder.com/content/QheGsopnoLVDs026wwbs1737776243.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically caused by a <strong>direct blow to the palm</strong>, such as from a <strong>poor golf swing</strong> or a fall onto the palm.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Pain</strong> localised to the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> side of the palm, often exacerbated by gripping.</li>\n<li><strong>Swelling</strong> and <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> over the hook of the hamate.</li>\n<li><strong>Difficulty in gripping objects</strong> due to pain and limited range of motion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>X-rays</strong> may show a <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> line in the hook of the <span class=\"customMeta\" data-dictid=\"67cb40545f16927771882e55a0620e\">hamate</span> or body of the hamate.</li>\n</ul>\n<p><img alt=\"\" data-author=\"Weerakkody Y, Hacking C, Niknejad M,\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/hamate-fracture-classification\" data-tags=\"\" height=\"770\" src=\"https://image.prepladder.com/content/mFmP4Le4VpntqF8RG35R1737776305.png\" width=\"500\"/></p>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>CT scans</strong> or <strong>MRIs</strong> are useful for confirming the diagnosis and assessing complications, such as <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> necrosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Immobilisation</strong> with a <strong>short arm cast</strong> for 4-6 weeks to allow for healing.</li>\n<li><strong>Excision</strong> of the hook of the <span class=\"customMeta\" data-dictid=\"67cb40545f16927771882e55a0620e\">hamate</span> may be necessary in cases of <span class=\"customMeta\" data-dictid=\"52a1dd8c4f1692777193dd58a0d51c\">nonunion</span> or persistent symptoms.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:455px\">\n<thead>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Carpal bone </strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Age of Appearance </strong></p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Capitate </strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>2nd month</p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Hamate </strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>3rd month (end)</p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Triquetral </strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>3rd year</p>\n</th>\n</tr>\n<tr>\n<th rowspan=\"2\" scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Lunate</strong></p>\n</th>\n<th rowspan=\"7\" scope=\"col\" style=\"vertical-align:top\">\n<p>4th year (females); 5th year (males)</p>\n</th>\n</tr>\n<tr>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Scaphoid</strong></p>\n</th>\n</tr>\n<tr>\n<th rowspan=\"2\" scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Trapezium</strong></p>\n</th>\n</tr>\n<tr>\n</tr>\n<tr>\n<th rowspan=\"2\" scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Trapezoid</strong></p>\n</th>\n</tr>\n<tr>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pisiform</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12th year (females); 9th to 10th year (males)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Gsjk3mBe88pt0BAAhDvD1743231087.mp3", "video": ""}, {"text": "Which of the following combinations of fracture and commonly injured nerves are correctly matched? a) Monteggia fracture - Posterior Interosseous Nerve b) Shaft of humerus fracture - Radial nerve c) Supracondylar fracture - Anterior Interosseous Nerve d) Hook of Hamate fracture - Deep branch of ulnar nerve", "options": [{"label": "A", "text": "a and b only", "correct": false}, {"label": "B", "text": "a, b, c only", "correct": false}, {"label": "C", "text": "a,b,c,d", "correct": true}, {"label": "D", "text": "a, b, d only", "correct": false}], "correct_answer": "C. a,b,c,d", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Shoulder <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Axillary nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Humeral <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radial nerve</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Supracondylar <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">Humerus</span> fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Median (mainly <strong>Anterior <span class=\"customMeta\" data-dictid=\"72b8cffc701692777190c03a6968ab\">Interosseous</span> nerve</strong>)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Holstein–Lewis fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radial nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Elbow <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> condyle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ulnar Nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Monteggia fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior <span class=\"customMeta\" data-dictid=\"72b8cffc701692777190c03a6968ab\">interosseous</span> nerve</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hook of <span class=\"customMeta\" data-dictid=\"67cb40545f16927771882e55a0620e\">Hamate</span> Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Deep branch of <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">Ulnar</span> nerve</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lunate Dislocation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Median nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hip <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sciatic nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Knee dislocation/Neck of <span class=\"customMeta\" data-dictid=\"9e7e90693316927772027cba1a6018\">Fibula</span> Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Peroneal nerve</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fed8qQbtqhPxtJyttzCz1743231419.mp3", "video": ""}, {"text": "A 3-week-old infant is brought to the clinic with a noticeable head tilt, as shown in the image. On examination, a firm mass is palpated in the neck region over the sternocleidomastoid muscle. Which of the following statements about this condition is not true?", "options": [{"label": "A", "text": "It is more common on the right side of the sternocleidomastoid.", "correct": false}, {"label": "B", "text": "The Head is tilted towards the same side as the affected muscle.", "correct": false}, {"label": "C", "text": "The mass is often localised near the clavicular attachment.", "correct": false}, {"label": "D", "text": "The mass typically attains maximum size by 1-2 years of age.", "correct": true}], "correct_answer": "D. The mass typically attains maximum size by 1-2 years of age.", "question_images": ["https://image.prepladder.com/content/ek1ODRkGoYJKN13IPYZN1748070035.png"], "explanation_images": ["https://image.prepladder.com/content/C4Ge50IEaOdsZ8gfOXNF1737776929.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/LuBF7WLKHSfK3T20mnQz1743231947.mp3", "video": ""}, {"text": "A 6-month-old child with a noticeable head tilt is found to have a mass over the sternocleidomastoid muscle. The clinician is considering potential secondary deformities that may develop due to the condition. Which of the following deformities is most commonly associated with the condition?", "options": [{"label": "A", "text": "Plagiocephaly", "correct": true}, {"label": "B", "text": "Kyphosis", "correct": false}, {"label": "C", "text": "Cervicothoracic Scoliosis", "correct": false}, {"label": "D", "text": "Lordosis", "correct": false}], "correct_answer": "A. Plagiocephaly", "question_images": ["https://image.prepladder.com/content/3ImLn5OR1XaemMppdLu11738845556.png"], "explanation_images": ["https://image.prepladder.com/content/ZpCzNxQkqZzvG2F5KZRR1737777077.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/uz9cfA8SOi61M8xSk8WX1743232098.mp3", "video": ""}, {"text": "A 5-month-old child presents with a persistent head tilt to the right. The clinician suspects possible congenital torticollis and considers possible associated syndromes. Which of the following syndromes is least likely to be associated with congenital torticollis?", "options": [{"label": "A", "text": "Morquio syndrome", "correct": false}, {"label": "B", "text": "Grisel Syndrome", "correct": false}, {"label": "C", "text": "Marfan syndrome", "correct": true}, {"label": "D", "text": "Down’s syndrome", "correct": false}], "correct_answer": "C. Marfan syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Gg4DzueuQgfGOSBbaxnV1737777155.png", "https://image.prepladder.com/content/YEuEWeF6XXZcA5w3FUQg1737777205.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Sed41thqJ7bL00Ge0Ugh1745059564.mp3", "video": ""}, {"text": "A 6-month-old infant is brought to the pediatric clinic with a noticeable head tilt to the left and a firm, palpable mass in the right sternocleidomastoid muscle. The parents report that the child favours turning the head to the left and seems uncomfortable. Which of the following management strategies is most appropriate for this child's condition?", "options": [{"label": "A", "text": "Immediate surgical intervention to prevent secondary deformities", "correct": false}, {"label": "B", "text": "Regular stretching exercises and physical therapy", "correct": true}, {"label": "C", "text": "Observation alone, as it resolves spontaneously", "correct": false}, {"label": "D", "text": "Use of a cervical collar to restrict head movement", "correct": false}], "correct_answer": "B. Regular stretching exercises and physical therapy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/t8OMQPZAkoTDpWopGcPF1745059695.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 25 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">